Agee, Jon Moore
Agee, Jon Moore is an individual health care provider with primary practice located at 404 E Elm St , Caldwell ID 83605-4846. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Agee, Jon Moore can be contacted via phone (208) 459-0028.Contact Information
Primary practice address
404 E Elm St
Caldwell ID 83605-4846
Phone: (208) 459-0028
Fax: (208) 459-0380
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | M-5972 | Idaho |
Profile Details
| NPI number | 1710941026 |
|---|---|
| LBN Legal business name | Agee, Jon Moore |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 13th, 2006 |
| Last updated | Jan 25th, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1710941026 | NPPES |
| Idaho | MEDICAID | 003570900 | |
| Idaho | Other | 000010004422 | |
| Idaho | Other | 59725 |
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