Organization
SURGICAL GROUP, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JON AGEE M.D. (PRESIDENT)
(208) 459-0028
Entity
Organization
Contact information
Practice address
404 E ELM ST, CALDWELL, ID 83605-4846
(208) 459-0028
(208) 459-0380
Mailing address
404 E ELM ST, CALDWELL, ID 83605-4846
(208) 459-0028
(208) 459-0380
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002483000
—
ID
01
—
87460
BLUE CROSS OF IDAHO
ID
Enumeration date
04/11/2006
Last updated
04/13/2010
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