Individual
JOHN DAVID MCDERMOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
3101 E STATE ST, SUITE 2120, EAGLE, ID 83616
(208) 473-3275
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PRA103
ID
Other
Enumeration date
05/18/2006
Last updated
09/04/2012
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