Individual
BENJAMIN J ATWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
3446 S 15TH E, IDAHO FALLS, ID 83404-8262
(208) 522-6335
(208) 522-0550
Mailing address
3446 S 15TH E, IDAHO FALLS, ID 83404-8262
(208) 522-6335
(208) 522-0550
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA1770
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA1770
LICENSE
ID
Enumeration date
08/23/2019
Last updated
04/04/2024
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