Individual
BENJAMIN KARL HOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1055 N CURTIS ROAD, BOISE, ID 83706-1309
(208) 367-2161
(208) 367-2989
Mailing address
PO BOX 9649, BOISE, ID 83707-4649
(208) 472-8100
(208) 472-8172
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
0101240775
VA
2085R0202X
Diagnostic Radiology Physician
Primary
M-11284
ID
2085R0202X
Diagnostic Radiology Physician
MD153638
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
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Other
Enumeration date
05/02/2007
Last updated
02/17/2012
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