Individual
ASHLEY W BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1070 N CURTIS RD STE 270, BOISE, ID 83706-1248
(304) 617-1511
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
102881
MO
208600000X
Surgery Physician
Primary
102881
MO
2086S0102X
Surgical Critical Care Physician
MC-0858
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2021049262
—
MO
Enumeration date
05/09/2007
Last updated
02/19/2025
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