Individual
DR. JONATHAN WALDEN HOUSLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 S 3RD W, SODA SPRINGS, ID 83276-1559
(208) 547-4961
(208) 547-3781
Mailing address
300 S 3RD W, SODA SPRINGS, ID 83276-1559
(208) 547-3341
(208) 547-2790
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M-9862
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1285970582
—
ID
Enumeration date
07/06/2006
Last updated
10/12/2022
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