Provider Demographics
NPI:1821117912
Name:STRADLING, BENJAMIN L (DO)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:L
Last Name:STRADLING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4200 UNIVERSITY AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-5945
Mailing Address - Country:US
Mailing Address - Phone:480-889-6598
Mailing Address - Fax:480-275-3538
Practice Address - Street 1:1301 S CRISMON RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-3767
Practice Address - Country:US
Practice Address - Phone:480-358-6578
Practice Address - Fax:480-358-6594
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-1134972085R0202X
IADO-45062085R0204X
IA45062085R0202X
AZ0050422085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology