Individual
JAY KOERNKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
500 W FORT ST # 111R, BOISE, ID 83702-4501
(816) 806-6566
Mailing address
500 W FORT ST # 111R, BOISE, ID 83702-4501
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
5771067
ID
Other
Enumeration date
03/29/2021
Last updated
11/21/2025
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