STANFORD BENJAMIN GAMMON


Address: 3200 Channing Way Ste 205a, Idaho Falls, ID 83404-7586
Phone: (208) 535-4580

STANFORD BENJAMIN GAMMON (NPI# 1477992592) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1477992592
Entity Type Individual
Full Name STANFORD BENJAMIN GAMMON
Credential P.A.
Practice Address 3200 Channing Way Ste 205a
Idaho Falls
ID 83404-7586
Practice Telephone (208) 535-4580
Practice Fax Number 2085354520
Mailing Telephone (208) 535-4580
Mailing Fax Number 2085354520
Enumeration Date 2013-06-21
Last Update Date 2017-09-08
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363AS0400X Physician Assistant
Specialization: Surgical Technologist
Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
WA 1477992592 05

Office Location

Street Address 3200 CHANNING WAY STE 205A
City IDAHO FALLS
State ID
Zip Code 83404-7586

Providers in the same location

NPI Name Taxonomy Address Enumeration
1497913008 Benjamin B Garner Orthopaedic Surgery 3200 Channing Way Ste 205a, Idaho Falls, ID 83404-7586 2008-05-30

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1437750809 Joshua M Murphy Dentist 1580 Elk Creek Dr., Idaho Falls, ID 83404 2020-11-03
1427618958 Eastern Idaho Endodontics Dentist 3335 S. Holmes Ave, Idaho Falls, ID 83404 2019-06-17
1942863600 Muhammad Arslan Khan Student in an Organized Health Care Education/Training Program 2860 Channing Way Suite 214, Idaho Falls, ID 83404 2019-04-18
1942771043 Physician's Choice Cardiology, Pllc Internal Medicine 3302 Valencia, Suite 201, Idaho Falls, ID 83404 2018-12-16
1609358761 Cardiac Cath Lab of Idaho Falls Internal Medicine 3311 Valencia Drive, Idaho Falls, ID 83404 2018-09-05
1083196380 Hannah Golden Occupational Therapist 1460 Elk Creek, Idaho Falls, ID 83404 2018-09-04
1316423049 Lindsay Sessions Speech-Language Pathologist 2210 Niagara St, Idaho Falls, ID 83404 2018-07-16
1720574023 Bmh, Inc. Anesthesiology 3302 Valencia Dr., Suite 201, Idaho Falls, ID 83404 2018-07-10
1093237935 Jason Earl Bailey Contractor 3100 S Woodruff Ave., Idaho Falls, ID 83404 2017-07-12
1235682121 Mountain Falls Quick Care Clinic/Center 1995 E 17th St #1, Idaho Falls, ID 83404 2016-07-27
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Taxonomy Information

Taxonomy Code 363AS0400X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant
Specialization Surgical Technologist

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1831647197 Nicholas Hensley Physician Assistant 3155 Channing Way Ste B, Idaho Falls, ID 83404-7534 2016-09-15
1386018950 Cody Fowler Physician Assistant 3345 Potomac Way, Idaho Falls, ID 83404-4978 2015-11-19
1033581269 Jason John Overocker Physician Assistant 3100 Channing Way, Idaho Falls, ID 83404-7533 2015-10-27

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1881218089 Michael Keegan Huntsman Physician Assistant 730 Aspen Ave, Shelley, ID 83274-1400 2020-06-03
1700447141 Katie Elizabeth Nichols Physician Assistant 1072 N Liberty St Ste 201, Boise, ID 83704 2019-06-26
1811369549 Anna Stoia Physician Assistant 4401 E. Tuscany Ave., Nampa, ID 83686 2015-10-21
1982937066 Don H Curtis Physician Assistant 348 W Bloomington Dr, Meridian, ID 83642-6942 2009-09-08
1801073655 Tracy D. Mickelsen Physician Assistant 3015 E Magic View Dr, Meridian, ID 83642-3743 2008-01-23
1356437172 Clare Elizabeth York Physician Assistant 805 Main St., Salmon, ID 83467 2006-10-05
1891707618 Brian Keith Lachapelle Physician Assistant 6140 W Curtisan, Ste 102, Boise, ID 83704 2006-08-12
1992743215 Bill Stahlberg Physician Assistant 211 Forest St, Mccall, ID 83638-5256 2006-06-02
1780641530 Alicia R Borst Physician Assistant 3960 W. Wainwright, Boise, ID 83713 2006-04-26
1275047409 Alexx Sliman Physician Assistant 425 Idaho St, Gooding, ID 83330-1258 2017-11-27
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Competitor

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City IDAHO FALLS
Zip Code 83404

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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