Individual
COREY T RAMMELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
393 E 2ND N, REXBURG, ID 83440-1605
(208) 356-3691
Mailing address
393 E 2ND N, REXBURG, ID 83440-1605
(208) 356-5401
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M6388
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010000817
BLUE SHIELD OF IDAHO ID#
ID
05
—
003900500
—
ID
01
—
M6388
STATE LICENSE #
ID
Enumeration date
09/27/2006
Last updated
04/15/2020
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