Provider Demographics
NPI:1720248305
Name:EARL, JAMES BENJAMIN (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BENJAMIN
Last Name:EARL
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:13923 W. WAINWRIGHT DR STE 301
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713
Mailing Address - Country:US
Mailing Address - Phone:208-938-5624
Mailing Address - Fax:208-938-5764
Practice Address - Street 1:13923 W. WAINWRIGHT DR STE 301
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713
Practice Address - Country:US
Practice Address - Phone:208-938-5624
Practice Address - Fax:208-938-5764
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-12414207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist