Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | M4907 | ID |
NPI | 1023068194 |
---|---|
Provider Name | Dr. Jeffrey Glenn Hessing |
First Address | Boise, ID 83704-4845 |
Second Address | Boise, ID 83704-4844 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 18/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000010005805 | REGENCE BLUE SHIELD (01) | ID |
003748000 | (05) | ID |
49072 | BLUE CROSS (01) | ID |
B63744 | (02) | ID |
P00297173 | TRAVELERS MEDICARE (01) | ID |