Healthcare Provider Details

I. General information

NPI: 1881633162
Provider Name (Legal Business Name): MATTHEW M BENDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 W CHINDEN BLVD
GARDEN CITY ID
83714-1463
US

IV. Provider business mailing address

PO BOX 191050
BOISE ID
83719-1050
US

V. Phone/Fax

Practice location:
  • Phone: 208-809-2865
  • Fax: 208-947-1945
Mailing address:
  • Phone: 208-955-6500
  • Fax: 208-955-6501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberM9026
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: