Individual
BENJAMIN BLAIR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2240 E CENTER ST, POCATELLO, ID 83201-2600
(208) 233-2100
(208) 233-3146
Mailing address
2240 E CENTER ST, POCATELLO, ID 83201-2600
(208) 233-2100
(208) 233-3146
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
M-7032
ID
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
M-7032
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1497883300
—
ID
01
—
185513400
US DEPT OF LABOR
ID
01
—
200034945
RAILROAD MEDICARE
ID
01
—
72405
BLUE CROSS OF ID
ID
Enumeration date
11/01/2006
Last updated
09/07/2021
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