Individual
JACOB BINGHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1501 HILAND AVE STE C, BURLEY, ID 83318-2682
(208) 677-6080
(208) 677-6090
Mailing address
5767 W CENTURY BLVD STE 400, LOS ANGELES, CA 90045-5631
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
M15808
ID
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
A168110
CA
390200000X
Student in an Organized Health Care Education/Training Program
MT208785
PA
Other
Enumeration date
05/21/2015
Last updated
03/07/2022
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