Provider Demographics
NPI:1215357645
Name:SCHOEPKE, BENJAMIN HUGH
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:HUGH
Last Name:SCHOEPKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:746 N BELVEDERE BLVD
Mailing Address - Street 2:APT 2
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38107-5057
Mailing Address - Country:US
Mailing Address - Phone:901-338-3499
Mailing Address - Fax:
Practice Address - Street 1:14003 SHOUP AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-6513
Practice Address - Country:US
Practice Address - Phone:901-338-3499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-24
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA156814207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty