Provider Demographics
NPI:1477647998
Name:CHUGG, JARED ANDERSON (MD)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:ANDERSON
Last Name:CHUGG
Suffix:
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:PO BOX 9649
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83707-4649
Mailing Address - Country:US
Mailing Address - Phone:208-472-8100
Mailing Address - Fax:208-471-8162
Practice Address - Street 1:1055 N CURTIS RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1309
Practice Address - Country:US
Practice Address - Phone:208-367-2161
Practice Address - Fax:208-367-2989
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV124482085R0202X
IN01058095A2085R0202X
CA1290142085R0202X
IDM-128772085R0202X
WY10128A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology