Individual
JAYSON LAVIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1072 N LIBERTY ST STE 200, BOISE, ID 83704-8963
(208) 302-4100
(208) 302-4135
Mailing address
PO BOX 190930, BOISE, ID 83719-0930
(208) 367-5170
(208) 302-5180
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
M-17334
ID
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
06/03/2014
Last updated
07/07/2023
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