Individual
JEFFREY S SHILT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
703 S AMERICANA BLVD, STE 120, BOISE, ID 83702-5099
(208) 323-2600
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
9901473
NC
207XP3100X
Pediatric Orthopaedic Surgery Physician
Primary
M10261
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200043936
RR MEDICARE
—
Enumeration date
12/15/2005
Last updated
02/18/2014
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