Basic Information
| Provider Information | |||||||||
| NPI: | 1508984287 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANNEST | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1657 | ||||||||
| Address2: | |||||||||
| City: | TWIN FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 833031657 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087343356 | ||||||||
| FaxNumber: | 2087339463 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 FALLS AVE W | ||||||||
| Address2: | |||||||||
| City: | TWIN FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 833013115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087343356 | ||||||||
| FaxNumber: | 2087339463 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2007 | ||||||||
| LastUpdateDate: | 11/02/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | M3751 | ID | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 001195800 | 05 | ID | MEDICAID |