Jefferson, Glenn E

Jefferson, Glenn E is an individual health care provider with primary practice located at 2315 8Th St , Lewiston ID 83501-7301. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Jefferson, Glenn E can be contacted via phone (208) 746-1383.

Contact Information

Primary practice address
2315 8Th St Lewiston ID 83501-7301
Phone: (208) 746-1383
Fax: (208) 746-6348
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X M4593 Idaho
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X MD00025241 Washington

Profile Details

NPI number 1326121286
LBN Legal business name Jefferson, Glenn E
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 23rd, 2006
Last updated Mar 8th, 2016 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1326121286 NPPES
Washington Other 31254 LABOR & INDUSTRIES
Washington Other 1326121286 LABOR & INDUSTRIES
Washington Other 1326121286 LABOR & INDUSTRIES
Washington MEDICAID 1007806 LABOR & INDUSTRIES
Washington MEDICAID 1326121286 LABOR & INDUSTRIES
Washington Other 80094289 LABOR & INDUSTRIES
Washington Other DF540 LABOR & INDUSTRIES
Washington Other 1119637 LABOR & INDUSTRIES

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