Individual
MR. BENJAMIN DON BURTENSHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
267 N CANYON DR, GOODING, ID 83330-5500
(208) 934-4433
Mailing address
611 PINE ST, GOODING, ID 83330-1755
(208) 220-6268
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-898
ID
363AM0700X
Medical Physician Assistant
4810
AZ
Other
Enumeration date
02/10/2011
Last updated
01/21/2013
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