Provider Demographics
NPI:1750490546
Name:ISBELL, R. DOUGLAS (MD)
Entity type:Individual
Prefix:DR
First Name:R.
Middle Name:DOUGLAS
Last Name:ISBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2065 E 17TH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-8042
Mailing Address - Country:US
Mailing Address - Phone:208-522-0747
Mailing Address - Fax:208-522-9641
Practice Address - Street 1:2065 E 17TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-8042
Practice Address - Country:US
Practice Address - Phone:208-522-0747
Practice Address - Fax:208-522-9641
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-4317207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002352400Medicaid
ID002352400Medicaid
ID1114713Medicare ID - Type Unspecified
ID002352400Medicaid