Individual
BENJAMIN L CORNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
500 W FORT ST, # 111, BOISE, ID 83702-4501
(208) 422-1325
(208) 422-1319
Mailing address
500 W FORT ST, # 111, BOISE, ID 83702-4501
(208) 422-1325
(208) 422-1319
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
M-10326
ID
207P00000X
Emergency Medicine Physician
MD429680
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1019649260001
—
PA
05
—
2791635
—
OH
05
—
3810009527
—
WV
05
—
808073400
—
ID
Enumeration date
07/25/2007
Last updated
09/29/2022
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