Provider Demographics
NPI:1477687929
Name:BEGLEY, BENJAMINW W (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMINW
Middle Name:W
Last Name:BEGLEY
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 1:2130 W 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-8044
Mailing Address - Country:US
Mailing Address - Phone:920-231-2828
Mailing Address - Fax:920-231-2848
Practice Address - Street 1:2130 W 9TH AVE
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-8044
Practice Address - Country:US
Practice Address - Phone:920-231-2828
Practice Address - Fax:920-231-2848
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI29405-020207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31837400Medicaid
WIF35250Medicare UPIN