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Search › Idaho › 207Q00000X

Glenn Jefferson, MD

NPI 1326121286 · on the registry since 2006

Practice

Address
1720 18th Ave
Lewiston, ID 83501
Phone
(208) 746-4097
Fax
(208) 746-2294
Organisation at this address
Phil Waggoner
Riverside Recovery Llc
Inferred from a shared address, not stated in the registry.
Clinicians at this address
18

Registry record

Primary taxonomy
207Q00000X
207Q00000X
Also registered as
207Q00000X
Licence states on file
WA, ID
From the registry's licence fields, which are often incomplete.
Sex
Male
Record last updated
2026-06-02

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Idaho