Search › Idaho › 363A00000X
Tai Banta
NPI 1467185843 · on the registry since 2022
Practice
- Address
- 3425 Merlin Dr Ste 200
Idaho Falls, ID 83404 - Phone
- (208) 528-6653
- Organisation at this address
- Mark E Hinkson Dermatology Pa
Inferred from a shared address, not stated in the registry.
- Clinicians at this address
- 4
Additional practice sites
- 921 S 8th Ave Stop 8253, Pocatello, ID
Registry record
- Primary taxonomy
- 363A00000X
363A00000X
- Also registered as
- 390200000X
- Licence states on file
- ID
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2026-08-12
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Idaho