Provider Demographics
NPI:1356645022
Name:BENJAMIN L STRADLING DO
Entity Type:Organization
Organization Name:BENJAMIN L STRADLING DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:STRADLING
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-776-7560
Mailing Address - Street 1:625 N GILBERT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-4609
Mailing Address - Country:US
Mailing Address - Phone:480-889-6598
Mailing Address - Fax:480-275-3538
Practice Address - Street 1:1301 S CRISMON RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-3767
Practice Address - Country:US
Practice Address - Phone:480-358-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0050422085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1821117912OtherINDIVIDUAL NPI
AZ388663Medicaid