Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | D-5135 | ID |
Y | 213EG0000X | General Practice | D-5135 | ID |
NPI | 1003438581 |
---|---|
Provider Name | Benjamin A Hulbert |
First Address | Boise, ID 83704-5202 |
Second Address | Boise, ID 83704-5202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2020 |
Last Update Date | 07/05/2020 |