Individual
DR. JESSE WILLIAM MIX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
500 W FORT ST, # 111, BOISE, ID 83702
(208) 422-1000
(208) 422-1319
Mailing address
500 W. FORT ST., # 111, BOISE, ID 83702
(208) 422-1000
(208) 422-1319
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
6880
AZ
207Q00000X
Family Medicine Physician
Primary
O-1380
ID
Other
Enumeration date
07/30/2012
Last updated
02/25/2022
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