Individual
KELBY JON WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
607 W MAIN ST, GRANGEVILLE, ID 83530-1345
(208) 983-1700
(208) 983-4665
Mailing address
607 W MAIN ST, GRANGEVILLE, ID 83530-1345
(208) 983-1700
(208) 983-4665
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M-14749
ID
Other
Enumeration date
06/20/2016
Last updated
09/30/2020
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