Healthcare Provider Details

I. General information

NPI: 1932166956
Provider Name (Legal Business Name): BRIAN KEITH BIZIK P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 03/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 FALLS AVENUE, SUITE 2 ASTHMA & ALERGY OF IDAHO
TWIN FALLS ID
83301
US

IV. Provider business mailing address

800 FALLS AVENUE, SUITE 2 ASTHMA & ALERGY OF IDAHO
TWIN FALLS ID
83301
US

V. Phone/Fax

Practice location:
  • Phone: 208-734-6091
  • Fax: 208-734-4654
Mailing address:
  • Phone: 208-734-6091
  • Fax: 208-734-4654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-453
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: