Healthcare Provider Details

I. General information

NPI: 1689237752
Provider Name (Legal Business Name): COLBY RAY BROWER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 S YELLOWSTONE HWY STE 103
REXBURG ID
83440-5565
US

IV. Provider business mailing address

1025 S YELLOWSTONE HWY STE 103
REXBURG ID
83440-5565
US

V. Phone/Fax

Practice location:
  • Phone: 208-317-7548
  • Fax: 208-516-4002
Mailing address:
  • Phone: 208-317-7548
  • Fax: 208-516-4002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM-15786
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: