Provider Demographics
NPI:1376835363
Name:JEFFREY L. CHANDLER, DPM
Entity Type:Organization
Organization Name:JEFFREY L. CHANDLER, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:208-344-3324
Mailing Address - Street 1:222 N 2ND ST STE 301
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6131
Mailing Address - Country:US
Mailing Address - Phone:208-344-3324
Mailing Address - Fax:208-344-4349
Practice Address - Street 1:222 N 2ND ST STE 301
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6131
Practice Address - Country:US
Practice Address - Phone:208-344-3324
Practice Address - Fax:208-344-4349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-09
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP-73332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
10015614OtherBLUE SHIELD OF IDAHO
ID1659354470Medicaid
IDP0730OtherBLUE CROSS IDAHO
480033367OtherRAILROAD MEDICARE
4182810001Medicare NSC
ID1659354470Medicaid