Individual
JADEN CUNNINGHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3100 CHANNING WAY, IDAHO FALLS, ID 83404-7533
(208) 529-6111
Mailing address
3100 CHANNING WAY, IDAHO FALLS, ID 83404-7533
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MRO-2402
ID
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
03/15/2024
Last updated
06/25/2024
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