Provider Demographics
NPI:1225053028
Name:LUMAN, BENJAMIN RYAN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:RYAN
Last Name:LUMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 ORPHEUS AVE
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2155
Mailing Address - Country:US
Mailing Address - Phone:503-915-3231
Mailing Address - Fax:
Practice Address - Street 1:724 ORPHEUS AVE
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2155
Practice Address - Country:US
Practice Address - Phone:503-915-3231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA01125363A00000X
CA51804363A00000X
AZ4637363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB228663Medicare PIN