Provider Demographics
NPI:1750644456
Name:ZIEBARTH, DUSTIN L (DO)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:L
Last Name:ZIEBARTH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 MARTIN ST
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-4544
Mailing Address - Country:US
Mailing Address - Phone:208-737-0451
Mailing Address - Fax:208-734-0452
Practice Address - Street 1:388 MARTIN ST
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4544
Practice Address - Country:US
Practice Address - Phone:208-737-0451
Practice Address - Fax:208-734-0452
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-0895207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1374819Medicare Oscar/Certification