Individual
BENJAMIN JACOB JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3200 CHANNING WAY STE 206, IDAHO FALLS, ID 83404-7546
(208) 529-2230
(208) 453-6142
Mailing address
PO BOX 277381, ATLANTA, GA 30384-7381
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-2256
ID
Other
Enumeration date
01/26/2022
Last updated
01/03/2023
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