Provider Demographics
NPI:1679771414
Name:STEPHENSON, BENJAMIN DAVID (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:DAVID
Last Name:STEPHENSON
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 1:1719 HIGHWAY 183
Mailing Address - Street 2:PO BOX 547
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:67661-2549
Mailing Address - Country:US
Mailing Address - Phone:785-543-5211
Mailing Address - Fax:785-543-5274
Practice Address - Street 1:1719 HIGHWAY 183
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:KS
Practice Address - Zip Code:67661-2549
Practice Address - Country:US
Practice Address - Phone:785-543-5211
Practice Address - Fax:785-543-5274
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0433764208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200689320BMedicaid
KS1679771414Medicare PIN