Individual
JONATHAN MOORE SHUPE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1919 LINCOLN WAY, 315, COEUR D ALENE, ID 83814-2527
(208) 625-6000
(208) 625-6001
Mailing address
2003 KOOTENAI HEALTH WAY, COEUR D ALENE, ID 83814-6051
(208) 625-5085
(208) 625-5731
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M12445
ID
Other
Enumeration date
06/06/2011
Last updated
07/23/2025
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