Individual
MR. PAUL BIENIASZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1000 N 8TH AVE, POCATELLO, ID 83201-5757
(208) 232-6260
Mailing address
500 S 11TH AVE STE 400, POCATELLO, ID 83201-4880
(208) 232-7862
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA 889
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1518934181
—
ID
Enumeration date
03/02/2006
Last updated
02/21/2024
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