Secrest, Alvin Jackson

Secrest, Alvin Jackson is an individual health care provider with primary practice located at 701 Lewiston St , Cottonwood ID 83522-9750. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Secrest, Alvin Jackson can be contacted via phone (208) 962-3267.

Contact Information

Primary practice address
701 Lewiston St Cottonwood ID 83522-9750
Phone: (208) 962-3267
Fax: (208) 962-2313
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X M6256 Idaho

Profile Details

NPI number 1053314864
LBN Legal business name Secrest, Alvin Jackson
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 24th, 2005
Last updated Aug 11th, 2021 - about 4 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 1053314864 NPPES
Idaho MEDICAID 002284400

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