Individual
JORDAN JOSEPH CORMIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2330 DESOTO ST, IDAHO FALLS, ID 83404-7570
(208) 552-4909
(208) 522-6101
Mailing address
2330 DESOTO ST, IDAHO FALLS, ID 83404-7570
(208) 552-4909
(208) 522-6101
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
PA-1568
ID
207RS0012X
Sleep Medicine (Internal Medicine) Physician
PA1568
ID
Other
Enumeration date
11/22/2017
Last updated
11/22/2017
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