Individual
JEB WILLIAM RODGERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 HOSPITAL DR, KETCHUM, ID 83340
(208) 727-8100
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
2017023064
MO
207P00000X
Emergency Medicine Physician
Primary
M-15000
ID
Other
Enumeration date
07/05/2017
Last updated
06/01/2022
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