Provider Demographics
NPI:1508984287
Name:ANNEST, JAMES T (MD PC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:T
Last Name:ANNEST
Suffix:
Gender:M
Credentials:MD PC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1657
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83303-1657
Mailing Address - Country:US
Mailing Address - Phone:208-734-3356
Mailing Address - Fax:208-733-9463
Practice Address - Street 1:115 FALLS AVE W
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3115
Practice Address - Country:US
Practice Address - Phone:208-734-3356
Practice Address - Fax:208-733-9463
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM3751207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID001195800Medicaid
ID1112018Medicare ID - Type Unspecified
ID001195800Medicaid