Individual
NEIL K BURRASTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2065 E 17TH ST STE A, IDAHO FALLS, ID 83404-8042
(208) 522-3301
(208) 522-3414
Mailing address
2065 E 17TH ST STE A, IDAHO FALLS, ID 83404-8042
(208) 522-3301
(208) 522-3414
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
O1960
ID
208D00000X
General Practice Physician
Primary
O-1960
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/23/2022
Last updated
04/22/2026
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