Provider Demographics
NPI:1003805037
Name:TERRY, BEN (DO)
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:
Last Name:TERRY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:217 W GEORGIA AVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-6811
Mailing Address - Country:US
Mailing Address - Phone:208-463-3000
Mailing Address - Fax:208-463-3034
Practice Address - Street 1:4400 E FLAMINGO AVE
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-9203
Practice Address - Country:US
Practice Address - Phone:208-288-4970
Practice Address - Fax:208-288-4990
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2007-07-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDO-225207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010027474OtherBLUE CROSS
ID08148209OtherRAILROAD MEDICARE
IDS3101OtherBLUE CROSS
ID000010027473OtherBLUE CROSS
IDS3119OtherBLUE CROSS
ID000010027474OtherBLUE CROSS
IDS3119OtherBLUE CROSS