Provider Demographics
NPI:1306026745
Name:JEWELL, CALVIN THOMAS (MD)
Entity Type:Individual
Prefix:MR
First Name:CALVIN
Middle Name:THOMAS
Last Name:JEWELL
Suffix:
Gender:M
Credentials:MD
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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:208-381-7190
Mailing Address - Fax:208-381-7191
Practice Address - Street 1:333 N 1ST ST
Practice Address - Street 2:SUITE 120
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6100
Practice Address - Country:US
Practice Address - Phone:208-381-7190
Practice Address - Fax:208-381-7191
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2011-02-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDM4006208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery