Provider Demographics
NPI:1922233980
Name:KLAUCKE, JILLIAN VERBY (MD)
Entity Type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:VERBY
Last Name:KLAUCKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JILLIAN
Other - Middle Name:H
Other - Last Name:VERBY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1323 HIGHWAY 2 STE 300
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-2741
Mailing Address - Country:US
Mailing Address - Phone:208-263-3091
Mailing Address - Fax:
Practice Address - Street 1:1323 HIGHWAY 2 STE 300
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-2741
Practice Address - Country:US
Practice Address - Phone:208-263-3091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM14353207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine