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General NPI Number Information
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NPI Number | 1922262542
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Entity Type | Individual
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Provider Name | JUSTUS FLIN LAMBSON PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/13/2008
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Last Update Date | 03/24/2016
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Provider Practice Location Address
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Address Line | 1595 YELLOWSTONE AVE
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City | POCATELLO
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State | ID
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Zip | 83201-4203
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Country | US
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Telephone | 208-233-0032
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Fax |
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Provider Business Mailing Address
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Address Line | 4472 TEEWINOT ST
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City | CHUBBUCK
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State | ID
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Zip | 83202-1736
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Country | US
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Telephone | 208-241-7248
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA2406
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA-1301
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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