Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | O0573 | ID |
NPI | 1689866451 |
---|---|
Provider Name | Dr. Benjamin M Tippets |
First Address | Boise, ID 83712-6241 |
Second Address | Boise, ID 83712-6267 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2007 |
Last Update Date | 21/08/2012 |