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Individual

BENJAMIN LEISHMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
1582 ELK CREEK DR, IDAHO FALLS, ID 83404-8322
(208) 881-0227
Mailing address
1582 ELK CREEK DR, IDAHO FALLS, ID 83404-8322
(208) 881-0227
(877) 682-5081

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
101-T1
WY
207Q00000X
Family Medicine Physician
Primary
101-T2
WY
207Q00000X
Family Medicine Physician
Primary
O-1351
ID
207QS0010X
Sports Medicine (Family Medicine) Physician
O-1351
ID
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
06/21/2016
Last updated
04/01/2026
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