Provider Demographics
NPI:1295841914
Name:SONNICHSEN, BEN WILLIAMS (MD)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:WILLIAMS
Last Name:SONNICHSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:TOPPENISH
Mailing Address - State:WA
Mailing Address - Zip Code:98948-0190
Mailing Address - Country:US
Mailing Address - Phone:509-865-5898
Mailing Address - Fax:509-865-3148
Practice Address - Street 1:820 MEMORIAL STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:PROSSER
Practice Address - State:WA
Practice Address - Zip Code:99350-2504
Practice Address - Country:US
Practice Address - Phone:509-786-2010
Practice Address - Fax:509-788-1794
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00017164207Q00000X
WAMD00029197207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1585801Medicaid
WA9392SOOtherREGENCE
911019392OtherCOMMERCIAL
WA0200685OtherL & I
1306897681OtherNPI PROSSER MEMORIAL
WA1585801OtherCHPW
WA1585801OtherCHPW
G8853889Medicare ID - Type Unspecified
WAA07395Medicare UPIN
WA9392SOOtherREGENCE