Provider Demographics
NPI:1073535506
Name:HASKELL, JEFFREY C X (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:C
Last Name:HASKELL
Suffix:X
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2470 JAFER CT
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-5587
Mailing Address - Country:US
Mailing Address - Phone:208-715-9990
Mailing Address - Fax:877-828-6821
Practice Address - Street 1:313 E ERA AVE
Practice Address - Street 2:
Practice Address - City:ARCO
Practice Address - State:ID
Practice Address - Zip Code:83213-8802
Practice Address - Country:US
Practice Address - Phone:208-569-4008
Practice Address - Fax:208-527-8265
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM6181170100000X, 208VP0000X, 207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003739200Medicaid
ID003739200Medicaid
ID1129788Medicare ID - Type Unspecified