Individual
JASON M ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1072 N LIBERTY ST, STE 200, BOISE, ID 83704
(208) 302-4600
(208) 302-4655
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642
(208) 302-4600
(208) 302-4655
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
M10380
ID
2080P0206X
Pediatric Gastroenterology Physician
Primary
M-10380
ID
Other
Enumeration date
05/15/2006
Last updated
04/25/2018
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