JACOB SUP

CALDWELL, ID
NPI1295266401
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy207Q00000X Family Medicine
(Licence: ID  O-1402)
Enumeration Date2017-03-21
Last Update Date2020-08-07
Business Address
JACOB SUP DO
2005 ARLINGTON AVE
CALDWELL, ID 83605-4808
Phone number: 208-459-1025
Mailing Address
JACOB SUP DO
PO BOX 9
NAMPA, ID 83653-0009
Phone number: 208-467-4431
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