Healthcare Provider Details

I. General information

NPI: 1497913008
Provider Name (Legal Business Name): BENJAMIN B GARNER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 07/21/2022
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 CHANNING WAY STE 205A
IDAHO FALLS ID
83404-7586
US

IV. Provider business mailing address

PO BOX 277381
ATLANTA GA
30384-7381
US

V. Phone/Fax

Practice location:
  • Phone: 208-535-4567
  • Fax: 208-535-4569
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOT006554T
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberO-0526
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: