Individual
JACOB RADIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
520 S EAGLE RD STE 1243, MERIDIAN, ID 83642-6355
(208) 333-2225
(208) 706-7516
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
LMSW # 33052
ID
363AS0400X
Surgical Physician Assistant
Primary
PA-2126
ID
Other
Enumeration date
07/02/2013
Last updated
01/17/2022
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