Provider Demographics
NPI:1588829402
Name:FELDMAN, BENJAMIN H (MD)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:H
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:625 POLE LINE RD W STE 2B
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4270
Practice Address - Country:US
Practice Address - Phone:208-814-7350
Practice Address - Fax:208-732-8508
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ57030207Y00000X
WI53719-020207Y00000X
IDM-17665207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDM-17665Medicaid
AZ467998Medicaid
AZ57030OtherAZ DEPARTMENT OF HEALTH SERVICES