Provider Demographics
NPI:1083867592
Name:WESTLEY, BENJAMIN P (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:P
Last Name:WESTLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3500 LATOUCHE STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4248
Mailing Address - Country:US
Mailing Address - Phone:907-561-4362
Mailing Address - Fax:907-563-4498
Practice Address - Street 1:3500 LATOUCHE STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4248
Practice Address - Country:US
Practice Address - Phone:907-561-4362
Practice Address - Fax:907-563-4498
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99178207R00000X, 208000000X
AK7171207R00000X, 208000000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1573643Medicaid