ROBERT E. JACKSON (NPI# 1184740045) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184740045 |
| Entity Type | Individual |
| Full Name | ROBERT E. JACKSON |
| Credential | M.D. |
| Practice Address |
520 S Eagle Rd Suite 3112 Boise ID 83712-6241 |
| Mailing Address |
190 E Bannock St Boise ID 83712-6241 |
| Practice Telephone | 2083812222 |
| Mailing Telephone | 2083812222 |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2013-12-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | 4301087650 | MI | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | 4301087650 | MI | Student, Health Care |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538701487 | Robert Jackson | Physical Therapist | 3056 Healthy Way Ste 116, Birmingham, AL 35243-2435 | 2019-10-11 |
| 1881003655 | Robert Donald Jackson | Social Worker | 151 Knollcroft Rd # 116d, Lyons, NJ 07939-5001 | 2014-08-06 |
| 1780005496 | Robert Earl Jackson Jr. | Community Health Worker | 17 Wickham Dr, Columbus, GA 31907-6328 | 2013-12-23 |
| 1073942371 | Robert Jackson | Massage Therapist | 502 11th St Se, Decatur, AL 35601-4908 | 2013-11-06 |
| 1447548573 | Robert Joseph Jackson | Licensed Practical Nurse | 5454 East State St, Hermitage, PA 16148 | 2011-07-11 |
| 1457515330 | Robert Anthony Jackson | Dentist | 2816 Veach Rd., Unit 305, Owensboro, KY 42303 | 2008-07-10 |
| 1437357399 | Robert D Jackson | Counselor | 5525 Erindale Dr Ste 112, Colorado Springs, CO 80918-6960 | 2007-07-03 |
| 1174736029 | Robert Allan Jackson | Physician Assistant | 2109 Brookview Ter Apt B, Pekin, IL 61554-7320 | 2007-05-08 |
| 1144389347 | Robert W Jackson | Dentist | 209 Mimosa Dr, Thomasville, GA 31792-6633 | 2006-12-06 |
| 1144305152 | Robert Eric Jackson | Internal Medicine | 291 Indian Lake Blvd, Hendersonville, TN 37075-3653 | 2006-10-26 |
| Street Address |
520 S EAGLE RD SUITE 3112 |
| City | BOISE |
| State | ID |
| Zip Code | 83712-6241 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477016012 | Veranda At Barber Station LLC | Assisted Living Facility | 3266 E. Barber Valley Drive, Boise, ID 83712 | 2019-04-10 |
| 1891258612 | Mary Elizabeth Riedel | Occupational Therapist | 190 E Bancock St., Boise, ID 83712 | 2019-04-09 |
| 1427523968 | Q17 Health Partners LLC | Surgery | 100 East Idaho Street #317, Boise, ID 83712 | 2018-10-11 |
| 1053898247 | Travis Dale Worwood | Social Worker | South Entrance, 1075 E. Park Blvd, Boise, ID 83712 | 2018-07-20 |
| 1689166761 | Kristen Nicole Ray | Social Worker | 109 E Bannock St, Boise, ID 83712 | 2018-06-04 |
| 1740706894 | Meghan Heitstuman | Social Worker | 190 E Bannock Street, Boise, ID 83712 | 2017-08-21 |
| 1942759725 | Kay Craig | Physical Therapist | 190 Bannock, Boise, ID 83712 | 2016-09-22 |
| 1235686395 | Sharon Bjornson | Physical Therapist | 190 East Bannack, Boise, ID 83712 | 2016-09-07 |
| 1033576491 | Heather Hussey | Genetic Counselor, MS | 100 E Idaho Street, Msti Genetics, Boise, ID 83712 | 2016-01-15 |
| 1295139137 | Amie Bartholomeus | Massage Therapist | 100 East Idaho Street, St Luke's Mountain States Tumor Institute, Boise, ID 83712 | 2014-10-21 |
| Find all providers in zip 83712 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316028889 | Edwin Manley Briggs | Urology | 1316 Harrison Blvd, Boise, ID 83702-3444 | 2006-10-18 |
| 1871549337 | Urology Associates, Pa | Urology | 125 E Idaho St Ste 303, Boise, ID 83712-6256 | 2006-05-26 |
| 1154323392 | Donald L Weese | Urology | 510 N 2nd St, Ste 103, Boise, ID 83702-6077 | 2005-06-01 |
| 1205939238 | David B Crane | Urology | 305 E Jefferson St, Ste 102, Boise, ID 83712-6273 | 2006-09-06 |
| 1154358067 | Michele B Ebbers | Urology | 305 E Jefferson St, Boise, ID 83712-6273 | 2006-06-27 |
| 1124055355 | Kara C Taggart | Urology | 510 N 2nd St, Suite 103, Boise, ID 83702-6077 | 2006-06-26 |
| 1538108311 | Stephen A. Brassell | Urology | 100 E Idaho St, Boise, ID 83712-6267 | 2006-06-06 |
| 1164461620 | Donald E Walker | Urology | 701 E Parkcenter Blvd, Boise, ID 83706-6528 | 2006-06-06 |
| 1437105954 | Larry A Tansey | Urology | 1000 N Curtis Rd, Ste 305, Boise, ID 83706-1337 | 2006-05-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699242123 | Treasure Valley Urology Pllc | Urology | 3090 E Gentry Way Ste 220, Meridian, ID 83642-3550 | 2018-11-02 |
| 1154682565 | Richard Alan Blatter | Urology | 2001 S Woodruff Ave Ste 4, Idaho Falls, ID 83404-6371 | 2012-06-01 |
| 1750648002 | Jason Orien | Urology | 777 Hospital Way Ste 215, Pocatello, ID 83201-5175 | 2012-04-11 |
| 1972892669 | David Flores | Urology | 980 W Ironwood Dr Ste 104, Coeur D Alene, ID 83814-2668 | 2011-04-04 |
| 1346407921 | Helen Jia-ru Kuo | Urology | 2855 E. Magic View Drive, Meridian, ID 83642 | 2008-05-21 |
| 1144344391 | Robert W. Bohus, M.d., F.a.c.s. | Urology | 500 S 11th Ave Ste 301, Pocatello, ID 83201-4879 | 2007-03-16 |
| 1346375235 | Edward D Ellison | Urology | 980 Ironwood Dr W, Ste 104, Coeur D' Alene, ID 83814 | 2007-02-22 |
| 1710097068 | Jared G Heiner | Urology | 3085 E Magic View Dr Ste 140, Meridian, ID 83642-3745 | 2006-08-30 |
| 1033121322 | Timothy Osborn Taylor | Urology | 2330 Coronado St, Idaho Falls, ID 83404-7407 | 2006-08-13 |
| 1689617722 | A P Mclaughlin IIi Apc | Urology | 120 N Leadville, Ketchum, ID 83340 | 2006-06-14 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.