Individual
JEFFREY KYLE LONGNION
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
500 W FORT ST, BOISE, ID 83702-4501
(208) 422-1000
Mailing address
500 W FORT ST, BOISE, ID 83702-4501
(208) 422-1000
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
2014-00510
NC
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
2014-00510
NC
390200000X
Student in an Organized Health Care Education/Training Program
157536
NC
Other
Enumeration date
06/18/2009
Last updated
02/05/2016
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