Individual
DR. JASON RYAN GREENHALGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
775 POLE LINE RD W, SUITE 301, TWIN FALLS, ID 83301-5814
(208) 814-8700
(208) 933-4914
Mailing address
PO BOX 587, TWIN FALLS, ID 83303-0587
(208) 814-7400
(208) 814-7491
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
M-11276
ID
208800000X
Urology Physician
R-7693
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1952478703
—
ID
01
—
P00983738
MCRR
ID
Enumeration date
11/29/2006
Last updated
12/29/2014
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