Individual
DR. JON PARKER WAGNILD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5610 GAGE ST, SUITE A, BOISE, ID 83706-1349
(208) 367-3370
Mailing address
984 W BOGUS VIEW CT, EAGLE, ID 83616-5878
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
M4213
ID
Other
Enumeration date
06/28/2006
Last updated
07/08/2007
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