Individual
BENJAMIN MERRILL PERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4664 N PENNGROVE WAY STE 100, MERIDIAN, ID 83646-7442
(208) 898-7467
(208) 398-2120
Mailing address
4664 N PENNGROVE WAY STE 100, MERIDIAN, ID 83646-7442
(208) 898-7467
(208) 398-2120
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
DO168846
OR
207N00000X
Dermatology Physician
Primary
O1145
ID
207ND0101X
MOHS-Micrographic Surgery Physician
O1145
ID
208D00000X
General Practice Physician
PG163364
OR
Other
Enumeration date
06/12/2013
Last updated
10/01/2020
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