Cooperrider, Jaclyn Marie

Cooperrider, Jaclyn Marie is an individual health care provider with primary practice located at 325 W Idaho St , Boise ID 83702-6040. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Sports Medicine. Allopathic & Osteopathic Physicians / Family Medicine is her primary health care specialty. Cooperrider, Jaclyn Marie can be contacted via phone (208) 514-2525.

Contact Information

Primary practice address
325 W Idaho St Boise ID 83702-6040
Phone: (208) 514-2525
Fax: (208) 375-2217
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X M-13130 Idaho
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X MRM-1390 Idaho
Allopathic & Osteopathic Physicians / Sports Medicine 207QS0010X M-13130 Idaho

Profile Details

NPI number 1518372846
LBN Legal business name Cooperrider, Jaclyn Marie
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 25th, 2014
Last updated Dec 15th, 2023 - 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1518372846 NPPES
Idaho MEDICAID 1518372846

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