Healthcare Provider Details

I. General information

NPI: 1396702395
Provider Name (Legal Business Name): SCOTT MARTIN ALBRIGHT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 12/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 SHOUP AVE W SUITE B
TWIN FALLS ID
83301-5042
US

IV. Provider business mailing address

PO BOX 587
TWIN FALLS ID
83303-0587
US

V. Phone/Fax

Practice location:
  • Phone: 208-814-9100
  • Fax: 208-814-9903
Mailing address:
  • Phone: 208-814-7400
  • Fax: 208-814-7491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberO-329
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: