Individual
DR. RANDALL L BENEDICT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
809 N LIBERTY ST, BOISE, ID 83704-8703
(208) 327-0627
(208) 376-5258
Mailing address
809 N LIBERTY ST, BOISE, ID 83704-8703
(208) 327-0627
(208) 376-5258
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
P133
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001970800
—
ID
Enumeration date
06/30/2006
Last updated
07/08/2007
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