Individual
DR. JEREMY B HAYMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1501 HILAND AVE, BURLEY, ID 83318-2682
(208) 677-6440
(208) 677-6455
Mailing address
1501 HILAND AVE, BURLEY, ID 83318-2682
(208) 677-6440
(208) 677-6455
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01062477A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200832230
—
IN
Enumeration date
08/19/2006
Last updated
06/30/2009
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