Provider Demographics
NPI:1457382723
Name:GILES, JONATHAN V (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:V
Last Name:GILES
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 1:190 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:208-381-2222
Mailing Address - Fax:
Practice Address - Street 1:3399 E LOUISE DR
Practice Address - Street 2:SUITE 400
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5047
Practice Address - Country:US
Practice Address - Phone:208-364-3000
Practice Address - Fax:208-364-3191
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM8195208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
020049568OtherRR MEDICARE
ID8059976WMedicaid
IDH41881Medicare UPIN
ID8059976WMedicaid
ID1101119Medicare PIN