Individual
JON MOORE AGEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
404 E ELM ST, CALDWELL, ID 83605-4846
(208) 459-0028
(208) 459-0380
Mailing address
PO BOX 742941, ATLANTA, GA 30374-2941
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
M-5972
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010004422
REGENCE BLUE SHIELD
ID
05
—
003570900
—
ID
01
—
59725
BLUE CROSS OF IDAHO
ID
Enumeration date
04/13/2006
Last updated
01/25/2022
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