Basic Information
| Provider Information | |||||||||
| NPI: | 1922365436 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AUSTIN | ||||||||
| FirstName: | COLBY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2840 9TH AVE E | ||||||||
| Address2: | |||||||||
| City: | TWIN FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 833018231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087315540 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2963 E COPPER POINT DR STE 150 | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836429056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083221730 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2012 | ||||||||
| LastUpdateDate: | 09/25/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD183530 | OR | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207PE0004X | M-12969 | ID | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
No ID Information.