Individual
JORDAN THOMAS LAUBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
6615 COMANCHE ST, BONNERS FERRY, ID 83805-7523
(208) 267-1718
Mailing address
6615 COMANCHE ST, BONNERS FERRY, ID 83805-7523
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-2724
ID
Other
Enumeration date
11/30/2023
Last updated
02/13/2024
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