Provider Demographics
NPI:1326023417
Name:HOCHHALTER, BENJAMIN J (PA-C)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:J
Last Name:HOCHHALTER
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 1:7455 W WASHINGTON AVE
Mailing Address - Street 2:#160
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-4337
Mailing Address - Country:US
Mailing Address - Phone:702-878-0393
Mailing Address - Fax:702-258-5536
Practice Address - Street 1:7455 W WASHINGTON AVE STE 160
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-4356
Practice Address - Country:US
Practice Address - Phone:702-878-0393
Practice Address - Fax:702-258-5536
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-614363A00000X, 363AM0700X, 363AS0400X
NVPA1844363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1326023417Medicaid
AZ282621Medicaid