Individual
J CLAYTON ROSCOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6565 W EMERALD ST, BOISE, ID 83704-8737
(208) 514-2510
(208) 375-2217
Mailing address
777 N RAYMOND ST, BOISE, ID 83704-9251
(208) 367-6030
(208) 367-6123
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M9164
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1871522086
—
ID
05
—
806357900
—
ID
Enumeration date
07/01/2006
Last updated
11/07/2018
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