Organization
JON-ERIC BAILLIE, MD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANENE RAYNE LMSW (OWNER/PARTNER)
(208) 377-3299
Entity
Organization
Contact information
Practice address
8100 W EMERALD ST STE 180, BOISE, ID 83704
(208) 377-3299
(208) 460-5227
Mailing address
8100 W EMERALD ST STE 180, BOISE, ID 83704-9069
(208) 377-3299
(208) 460-5227
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
M-7882
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M-7882
IDAHO MEDICAL LICENSE
ID
Enumeration date
08/15/2013
Last updated
06/13/2018
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