Individual
JEFFREY S DZIECZKOWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6140 W CURTISIAN, SUITE 300, BOISE, ID 83704-0107
(208) 367-6575
(208) 367-7100
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642-1026
(208) 367-5170
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M9510
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807334900
—
ID
Enumeration date
06/06/2006
Last updated
02/20/2013
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