Provider Demographics
NPI:1952308082
Name:PEASE, BENJAMIN CLARK (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:CLARK
Last Name:PEASE
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 1:4201 ANDERSON AVE
Mailing Address - Street 2:BLDG. C
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-7601
Mailing Address - Country:US
Mailing Address - Phone:785-539-3504
Mailing Address - Fax:785-539-7430
Practice Address - Street 1:4201 ANDERSON AVE
Practice Address - Street 2:BLDG. C
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-7601
Practice Address - Country:US
Practice Address - Phone:785-539-3504
Practice Address - Fax:785-539-7430
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-26124207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100288270BMedicaid
KSPE054547Medicare ID - Type Unspecified
KS100288270BMedicaid