Provider Demographics
NPI:1619266608
Name:LAMBERTSON, BENJAMIN DASHIELL (DO)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:DASHIELL
Last Name:LAMBERTSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E 104TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-4517
Mailing Address - Country:US
Mailing Address - Phone:816-251-5200
Mailing Address - Fax:816-251-5299
Practice Address - Street 1:4801 S CLIFF AVE STE 300
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-6954
Practice Address - Country:US
Practice Address - Phone:816-251-5200
Practice Address - Fax:816-251-5299
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN57805207Q00000X
MO2021037240207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1619266608Medicare PIN