Individual
JACESON BANHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1957 E 17TH ST, IDAHO FALLS, ID 83404-6429
(208) 523-1100
Mailing address
1957 E 17TH ST, IDAHO FALLS, ID 83404-6429
(208) 523-1100
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
8671842
ID
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
01/03/2025
Last updated
06/08/2026
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