Individual
MR. JEREMY B OSTERMILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
320 WARNER DRIVE, LEWISTON, ID 83501
(208) 791-9889
Mailing address
320 WARNER DRIVE, LEWISTON, ID 83501
(208) 791-9889
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA10004462
WA
363A00000X
Physician Assistant
Primary
PA435
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010142606
REGENCE
ID
05
—
8358517
—
WA
01
—
PALL2
BLUE CROSS OF IDAHO
ID
Enumeration date
11/16/2006
Last updated
12/26/2007
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