Provider Demographics
NPI:1376174235
Name:STRAHAN, BENJAMIN MICHAEL
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:MICHAEL
Last Name:STRAHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 RIKISHA LN
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-3535
Mailing Address - Country:US
Mailing Address - Phone:409-679-4607
Mailing Address - Fax:
Practice Address - Street 1:755 N 11TH ST STE P3200
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1518
Practice Address - Country:US
Practice Address - Phone:409-347-6907
Practice Address - Fax:409-899-5670
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX861730208800000X
TXAP144712363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No208800000XAllopathic & Osteopathic PhysiciansUrology