Provider Demographics
NPI:1710968516
Name:WALLISCH, BENJAMIN JOHN (DO)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:JOHN
Last Name:WALLISCH
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1515 HOLCOMBE BLVD STE 409
Mailing Address - Street 2:MD ANDERSON DEPARTMENT OF ANESTHESIOLOGY
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4000
Mailing Address - Country:US
Mailing Address - Phone:713-647-6547
Mailing Address - Fax:
Practice Address - Street 1:1515 HOLCOMBE BLVD STE 409
Practice Address - Street 2:MD ANDERSON DEPARTMENT OF ANESTHESIOLOGY
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4000
Practice Address - Country:US
Practice Address - Phone:713-647-6547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN02002883A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology