Provider Demographics
NPI:1821306648
Name:ASHLOCK, BENTON (MD)
Entity Type:Individual
Prefix:
First Name:BENTON
Middle Name:
Last Name:ASHLOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BENTON
Other - Middle Name:
Other - Last Name:ASHLOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 62106
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93160-2106
Mailing Address - Country:US
Mailing Address - Phone:805-898-3400
Mailing Address - Fax:805-898-3420
Practice Address - Street 1:301 W PUEBLO ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4310
Practice Address - Country:US
Practice Address - Phone:805-898-3400
Practice Address - Fax:805-898-3420
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA118255207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA118255OtherSTATE LICENSE