Provider Demographics
NPI:1487607198
Name:MENZNER, JEFFRY P (MD)
Entity type:Individual
Prefix:
First Name:JEFFRY
Middle Name:P
Last Name:MENZNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:208-323-2600
Mailing Address - Fax:
Practice Address - Street 1:703 S AMERICANA BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5099
Practice Address - Country:US
Practice Address - Phone:208-323-2600
Practice Address - Fax:208-375-2419
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM7573207X00000X
IDM-7573207XS0114X, 207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID20000789Medicare PIN