Individual
MR. JEREMY SHUPPERD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPO
Contact information
Practice address
427 N CURTIS RD, BOISE, ID 83706-1439
(208) 342-4104
(208) 342-4106
Mailing address
427 N CURTIS RD, BOISE, ID 83706-1439
(208) 342-4104
(208) 342-4106
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
—
—
224P00000X
Prosthetist
Primary
—
—
Other
Enumeration date
04/04/2024
Last updated
04/04/2024
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