Provider Demographics
NPI:1205491164
Name:WAINBLAT, BENJAMIN ISAAC (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ISAAC
Last Name:WAINBLAT
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 NICHOLLS ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99122-9729
Mailing Address - Country:US
Mailing Address - Phone:509-725-7101
Mailing Address - Fax:
Practice Address - Street 1:10 NICHOLLS ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:WA
Practice Address - Zip Code:99122-9729
Practice Address - Country:US
Practice Address - Phone:509-725-7101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIMLC.MD.61566197207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine