Doctor Name: | MR. BENJAMIN DON BURTENSHAW |
NPI Number: | 1437455318 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | 4810 |
Business Practice Address: | 267 N Canyon Dr Gooding, ID - 833305500 |
Business Phone Number: | 2089344433 |
Business Fax Number: | |
Mailing Address: | 611 Pine St, GOODING |
State: | ID |
Postal Code: | 833301755 |
Phone Number: | 2082206268 |
Fax Number: | |
NPI Enumeration Date: | 02/10/2011 |
NPI Last Update Date: | 01/21/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 4810 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | AZ |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |