Provider Demographics
NPI:1528356490
Name:BENHAM, JOSEPH RANDALL (RPA,RA)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:RANDALL
Last Name:BENHAM
Suffix:
Gender:M
Credentials:RPA,RA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870 TOLTEC MOUNDS RD
Mailing Address - Street 2:
Mailing Address - City:ENGLAND
Mailing Address - State:AR
Mailing Address - Zip Code:72046-8941
Mailing Address - Country:US
Mailing Address - Phone:501-351-0199
Mailing Address - Fax:
Practice Address - Street 1:9601 LILE DR STE 1100
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6333
Practice Address - Country:US
Practice Address - Phone:501-227-5240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARRPA-2383243U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant