Individual
JON L HLAVINKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
300 E BANNOCK ST, BOISE, ID 83712-6207
(208) 342-7400
(208) 342-7400
Mailing address
300 E BANNOCK ST, BOISE, ID 83712-6207
(208) 342-7400
(208) 342-1879
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M6008
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010004642
BLUE SHIELD
ID
05
—
002364500
—
ID
01
—
105443
BLUE CROSS
ID
01
—
806359300
HEALTHY CONNECTIONS
ID
Enumeration date
10/21/2005
Last updated
03/29/2023
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