NPI 1114957362

Kelly L Dustin, DO

Practitioner Family Medicine Physician Rexburg, ID

Practice location

Address: 21 Winn Dr, Rexburg, ID 83440-5277
Phone: (208) 881-5222
Fax: (877) 441-4715
Mailing address: 794 Eastland Dr, Twin Falls, ID 83301-6856

Registered specialties (2)

Family Medicine Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207Q00000X Licence O-0459 (ID)

Other Family Medicine providers in Idaho →

Student in an Organized Health Care Education/Training Program

Student, Health Care Taxonomy 390200000X Licence MR0875 (ID)

Other Student in an Organized Health Care Education/Training Program providers in Idaho →

Registry record

NPI: 1114957362
Entity type: Individual
Sex (as registered): Male
NPI issued: 4 Jul 2006
Record last updated: 19 Nov 2019

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.