Healthcare Provider Details

I. General information

NPI: 1124306295
Provider Name (Legal Business Name): AUSTIN HEATH RASMUSSEN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2011
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

637 PINE ST
GOODING ID
83330-1755
US

IV. Provider business mailing address

637 PINE ST
GOODING ID
83330-1755
US

V. Phone/Fax

Practice location:
  • Phone: 208-934-8390
  • Fax:
Mailing address:
  • Phone: 208-934-8390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number60236691
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA-1045
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: