Individual
DR. ERIC BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2775 CHANNING WAY, IDAHO FALLS, ID 83404-7510
(208) 524-0133
Mailing address
2775 CHANNING WAY, IDAHO FALLS, ID 83404-7510
(208) 529-9060
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
10939737-1205
UT
207Q00000X
Family Medicine Physician
Primary
M-14988
ID
390200000X
Student in an Organized Health Care Education/Training Program
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—
Other
Enumeration date
03/19/2017
Last updated
12/02/2020
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