Individual
MR. CORBIN BUNNAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
740 S WOODRUFF AVE, IDAHO FALLS, ID 83401-5285
(208) 542-9111
(208) 542-9114
Mailing address
915 SOUTH UTAH AVENUE #100, IDAHO FALLS, ID 83402
(208) 542-7000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA-267
ID
363AM0700X
Medical Physician Assistant
Primary
PA-267
ID
Other
Enumeration date
11/22/2006
Last updated
03/07/2023
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