Provider Demographics
NPI:1104065861
Name:R.K. ARBON, M.D., P.A.
Entity type:Organization
Organization Name:R.K. ARBON, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:R.K.
Authorized Official - Middle Name:
Authorized Official - Last Name:ARBON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-529-0575
Mailing Address - Street 1:2860 CHANNING WAY
Mailing Address - Street 2:SUITE 116
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7541
Mailing Address - Country:US
Mailing Address - Phone:208-529-0575
Mailing Address - Fax:208-528-0223
Practice Address - Street 1:2860 CHANNING WAY
Practice Address - Street 2:SUITE 116
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7531
Practice Address - Country:US
Practice Address - Phone:208-529-0575
Practice Address - Fax:208-528-0223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM2465207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010005517OtherREGENCE BLUE SHIELD
ID001102300Medicaid
ID2465-3OtherBLE CROSS OF IDAHO
ID000010005517OtherREGENCE BLUE SHIELD
IDB63143Medicare UPIN