Individual
BRANT JAOUEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2235
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-8752
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
56434
AZ
207P00000X
Emergency Medicine Physician
Primary
MC-1553
ID
Other
Enumeration date
04/15/2016
Last updated
09/12/2022
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