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Contact Information

JAY W WILLEY, DO
495 YELLOWSTONE AVE
POCATELLO, ID83201-4531
 Phone: 208-478-7422
 Fax: 208-478-1515
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family Medicine

207Q00000X 08 Physician/Family Practice
Indicates primary specialty

NPI Profile & details for JAY W WILLEY · (Male)

NPI Number 1922029412
Credentials DO (Doctor of Osteopathic)
Entity Individual
Enumeration date 07/21/2006
Last updated 07/08/2007 - About 9 years ago
Sole proprietor 1 No
Identifiers
ID License # O314
ID Medicare UPIN G63436
Hospital affiliation(s)
  • BINGHAM MEMORIAL HOSPITAL - (Critical Access)
    98 POPLAR STREET
    BLACKFOOT, ID 83221
  • PORTNEUF MEDICAL CENTER - (Acute Care)
    777 HOSPITAL WAY
    POCATELLO, ID 83201
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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