JACESON BANHAM

IDAHO FALLS, ID
NPI1295544344
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363A00000X Physician Assistant
Enumeration Date2025-01-03
Last Update Date2025-01-03
Business Address
JACESON BANHAM PA-C
3425 POTOMAC WAY
IDAHO FALLS, ID 83404-4984
Phone number: 208-528-8170
Mailing Address
JACESON BANHAM PA-C
PO BOX 291
PROVIDENCE, UT 84332-0291
Phone number:
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