Provider Demographics
NPI:1609674738
Name:EDMONDS, COLBY DOUGLAS
Entity type:Individual
Prefix:
First Name:COLBY
Middle Name:DOUGLAS
Last Name:EDMONDS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 N 4440 E
Mailing Address - Street 2:
Mailing Address - City:RIGBY
Mailing Address - State:ID
Mailing Address - Zip Code:83442-5887
Mailing Address - Country:US
Mailing Address - Phone:707-590-4449
Mailing Address - Fax:
Practice Address - Street 1:334 N 4440 E
Practice Address - Street 2:
Practice Address - City:RIGBY
Practice Address - State:ID
Practice Address - Zip Code:83442-5887
Practice Address - Country:US
Practice Address - Phone:707-590-4449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID4071459207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine