Individual
JED BURKE WILLARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2377 CORONADO ST, SUITE C, IDAHO FALLS, ID 83404-7440
(208) 523-7246
(208) 523-7247
Mailing address
PO BOX 2404, IDAHO FALLS, ID 83403-2404
(208) 523-7246
(208) 523-7247
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-779
ID
Other
Enumeration date
10/28/2008
Last updated
03/04/2009
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