Destin Thayne Bep INC

NPI #1790244424 in Rexburg, Idaho

Provider Information

NPI Number: 1790244424
Entity Type: Organization
Organization Name: Destin Thayne Bep INC
Primary Specialty: Family Medicine
Enumeration Date: Mar 12, 2019
Last Updated: Aug 12, 2021

Practice Location

Address: 859 S YELLOWSTONE HWY STE 3201
City: Rexburg
State: Idaho
ZIP Code: 83440-6200
Phone: (208) 359-2101

Authorized Official

Name: DESTIN L THAYNE
Title: OWNER
Phone: (208) 359-2101

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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