Individual
MR. JEFFRIE NEIL MAYBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDMT
Contact information
Practice address
90 HOPE DR BLDG 6000, MOUNTAIN HOME A F B, ID 83648-1062
(208) 828-7100
Mailing address
90 HOPE DR BLDG 6000, MOUNTAIN HOME A F B, ID 83648-1062
(208) 828-7100
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
—
—
Other
Enumeration date
07/23/2009
Last updated
07/23/2009
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