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NPI Code Detail

MEDICARE: COREY T RAMMELL MD

MEDICARE: COREY T RAMMELL MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianM6388ID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1M6388OTHERIDSTATE LICENSE #
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3000010000817OTHERIDBLUE SHIELD OF IDAHO ID#

General Provider Information

NPI Number : 1013008697
Entity Type Code : Individual
Provider Name (Legal Business Name) : COREY T RAMMELL MD
Provider Business Mailing Address
First Line : 393 E 2ND N
Second Line :
City : REXBURG
State : ID
Zip : 83440-1605
Country : US
Telephone Number : 208-356-5401
Fax Number :
Provider Business Practice Location Address
First Line : 393 E 2ND N
Second Line :
City : REXBURG
State : ID
Zip : 83440-1605
Country : US
Telephone Number : 208-356-3691
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2006
Last Update Date : 04/15/2020

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Directions to “ COREY T RAMMELL MD” Practice Location

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