Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | M7573 | ID |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | M-7573 | ID |
N | 207XX0801X | Orthopaedic Trauma Surgeon | M-7573 | ID |
NPI | 1487607198 |
---|---|
Provider Name | Jeffry P Menzner |
First Address | Boise, ID 83712-6241 |
Second Address | Boise, ID 83702-5099 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 17/10/2013 |