MEDICARE: KIRBY TAYLOR BENSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1073273280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRBY TAYLOR BENSON

Provider Business Mailing Address
First Line	:	1955 W GUADALUPE RD # 1
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85202-7487
Country	:	US
Telephone Number	:	480-827-5620
Fax Number	:

Provider Business Practice Location Address
First Line	:	1955 W GUADALUPE RD # 1
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85202-7487
Country	:	US
Telephone Number	:	480-827-5620
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2021
Last Update Date	:	05/22/2024

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Directions to “ KIRBY TAYLOR BENSON ” Practice Location

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