Individual
COLTON JASON RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
775 POLE LINE RD W STE 112, TWIN FALLS, ID 83301-5819
(208) 814-8200
(208) 933-4921
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1928
ID
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
06/10/2020
Last updated
02/09/2026
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