Individual
LANIE BENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
460 N 3RD E, DRIGGS, ID 83422-5146
(208) 821-2141
Mailing address
PO BOX 847, DRIGGS, ID 83422-0847
(208) 821-2141
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
D9358
TX
Other
Enumeration date
07/22/2014
Last updated
07/22/2014
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