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Organization
BENJAMIN BLAIR, MD PA
Active
Organization
BENJAMIN BLAIR, MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BENJAMIN BLAIR MD (PRESIDENT)
(208) 233-2100
Entity
Organization
Contact information
Practice address
2240 E CENTER ST, POCATELLO, ID 83201-2600
(208) 233-2100
(208) 233-3146
Mailing address
2240 E CENTER ST, POCATELLO, ID 83201-2600
(208) 233-2100
(208) 233-3146
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
M7032
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000100002014
BLUE SHIELD OF IDAHO
ID
05
—
002756000
—
ID
01
—
185513400
US DEPT OF LABOR
—
01
—
8K305
BLUE CROSS GROUP ID #
ID
01
—
DA7257
RAILROAD MEDICARE GRP ID
—
Enumeration date
03/01/2007
Last updated
09/07/2021
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