Individual
JAY T THIEMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ST
Contact information
Practice address
623 S MAIN ST, SUITE 6, MOSCOW, ID 83843-2983
(208) 883-2828
(208) 882-2179
Mailing address
623 S MAIN ST, SUITE 6, MOSCOW, ID 83843-2983
(208) 883-2828
(208) 882-2179
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
ST00002460
WA
Other
Enumeration date
11/21/2006
Last updated
07/08/2007
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