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Individual

JEREMY SCOTT MIHU

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
2280 E 25TH ST, IDAHO FALLS, ID 83404-7542
(208) 529-6111
Mailing address
PO BOX 742358, ATLANTA, GA 30374-2358

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1786
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1166047
NCCPA
01
PA-1786
IDAHO STATE BOARD OF MEDICINE
ID
Enumeration date
10/21/2019
Last updated
01/15/2020
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