Provider Demographics
NPI:1649097668
Name:CAUTHORN, BENEDICT IGNATIUS (CRM AND PSSC)
Entity type:Individual
Prefix:
First Name:BENEDICT
Middle Name:IGNATIUS
Last Name:CAUTHORN
Suffix:
Gender:M
Credentials:CRM AND PSSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 NE BURNSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-5122
Mailing Address - Country:US
Mailing Address - Phone:458-201-1590
Mailing Address - Fax:
Practice Address - Street 1:401 NE BURNSIDE AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-5122
Practice Address - Country:US
Practice Address - Phone:458-201-1590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-21
Last Update Date:2024-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24-CRM-3631175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist