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Ethan Bonham
NPI 1588596829 · on the registry since 2026
Practice
- Address
- 921 S 8th Ave
Pocatello, ID 83201 - Phone
- (816) 977-7323
- Organisation at this address
- Idaho State University
Inferred from a shared address, not stated in the registry.
- Clinicians at this address
- 39
Registry record
- Primary taxonomy
- 101YP2500X
101YP2500X
- Also registered as
- 101YM0800X
- Licence states on file
- ID
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- 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