Gertjan Mulder, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

M4931 Issued in ID

Practice address

3301 N Sawgrass Way
Boise, ID 83704-4493

Phone

(208) 375-0862

Fax

(208) 375-2658

NPI assigned

Apr 20, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Jerry Mulder Other name

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• St Lukes Clinic-Treasure Valley LLC

  • Family Medicine Physician
  • Boise, ID
  • NPI 1326336058
  NPD
• St Lukes Clinic-Treasure Valley LLC

  • Family Medicine Physician
  • Mountain Home, ID
  • NPI 1417297821
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1390435200000",
    "number": "1659336691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 E BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126241",
            "telephone_number": "208-375-0862",
            "fax_number": "208-375-2658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3301 N SAWGRASS WAY",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837044493",
            "telephone_number": "208-375-0862",
            "fax_number": "208-375-2658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULDER",
        "first_name": "GERTJAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-20",
        "last_updated": "2014-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M4931",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JERRY",
            "last_name": "MULDER",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Daniel Mueller
• Deborah Mueller, LCPC
• Debra G. Mueller, LMSW
• Kacey E Mueller
• Sunny Louise Muirhead, BCBA
• Leah Muldoon, NP
• Benoit Mulendela
• Vicky Mulendela
• Samuel Taylor Mulford, PT, DPT
• Benjamin Mulkey, CSFA

• Family Medicine Physician in Boise, ID
• Providers in Boise, ID by specialty
• Family Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.