Basic Information
| Provider Information | |||||||||
| NPI: | 1952537060 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JURGENSMEIER | ||||||||
| FirstName: | DARIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3340 E GOLDSTONE WAY | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836421026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083770777 | ||||||||
| FaxNumber: | 2083771070 | ||||||||
| Practice Location | |||||||||
| Address1: | 6165 W EMERALD STREET | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837048613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083770777 | ||||||||
| FaxNumber: | 2083771070 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2009 | ||||||||
| LastUpdateDate: | 02/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | M-12854 | ID | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 207X00000X | M-12854 | ID | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 35123184 | OH | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | MT195504 | PA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.