Jacob Sup, DO

NPI #1295266401 in Caldwell, Idaho

Provider Information

NPI Number: 1295266401
Entity Type: Individual
Name: Jacob Sup, DO
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Family Medicine
Credential: DO
Enumeration Date: Mar 21, 2017
Last Updated: Aug 7, 2020

Practice Location

Address: 2005 ARLINGTON AVE
City: Caldwell
State: Idaho
ZIP Code: 83605-4808
Phone: (208) 459-1025

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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