Individual
JESSE TYLER MCCHANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
207 1ST ST S, NAMPA, ID 83651-3703
(208) 466-7869
(208) 466-5359
Mailing address
PO BOX 9, NAMPA, ID 83653-0009
(208) 461-7149
(208) 467-3391
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M-16990
ID
207Q00000X
Family Medicine Physician
MRM-2026
ID
Other
Enumeration date
05/04/2021
Last updated
09/17/2024
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