Smith, Justin G

Smith, Justin G is an individual health care provider with primary practice located at 132 5Th Ave W Suite 1, Jerome ID 83338-1825. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Smith, Justin G can be contacted via phone (208) 814-9800.

Contact Information

Primary practice address
132 5Th Ave W Suite 1 Jerome ID 83338-1825
Phone: (208) 814-9800
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X M-12489 Idaho

Profile Details

NPI number 1851612600
LBN Legal business name Smith, Justin G
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 16th, 2010
Last updated Sep 5th, 2014 - about 11 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 1851612600 NPPES
Idaho MEDICAID 1851612600

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