| Destin Thayne Bep Inc | |
|
859 S Yellowstone Hwy Ste 3201 Rexburg ID 83440-6200 | |
| (208) 359-2101 | |
| (208) 356-8860 |
| Full Name | Destin Thayne Bep Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 859 S Yellowstone Hwy Ste 3201, Rexburg, Idaho |
| Authorized Official Name and Position | Destin L Thayne (OWNER) |
| Authorized Official Contact | 2083592101 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Destin Thayne Bep Inc 859 S Yellowstone Hwy Ste 3201 Rexburg ID 83440-6200 Ph: (208) 359-2101 | Destin Thayne Bep Inc 859 S Yellowstone Hwy Ste 3201 Rexburg ID 83440-6200 Ph: (208) 359-2101 |
| NPI Number | 1790244424 |
|---|---|
| Provider Enumeration Date | 03/12/2019 |
| Last Update Date | 08/12/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790244424 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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