Provider Demographics
NPI:1801036538
Name:SAMUEL D. BENJAMIN MD, MD(H), PLLC
Entity Type:Organization
Organization Name:SAMUEL D. BENJAMIN MD, MD(H), PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:DORIAN
Authorized Official - Last Name:BENJAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-661-1880
Mailing Address - Street 1:15721 N GREENWAY HAYDEN LOOP
Mailing Address - Street 2:#103
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260
Mailing Address - Country:US
Mailing Address - Phone:480-661-1880
Mailing Address - Fax:480-661-1890
Practice Address - Street 1:15721 N GREENWAY HAYDEN LOOP
Practice Address - Street 2:#103
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260
Practice Address - Country:US
Practice Address - Phone:480-661-1880
Practice Address - Fax:480-661-1890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13742207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1063625424OtherNPI
AZ127749Medicare UPIN