MEDICARE: DR. BENJAMIN CLARK PEASE M.D.

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	207Y00000X	Otolaryngology Physician	04-26124	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952308082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN CLARK PEASE M.D.

Provider Business Mailing Address
First Line	:	4201 ANDERSON AVE
Second Line	:	BLDG. C
City	:	MANHATTAN
State	:	KS
Zip	:	66503-7601
Country	:	US
Telephone Number	:	785-539-3504
Fax Number	:	785-539-7430

Provider Business Practice Location Address
First Line	:	4201 ANDERSON AVE
Second Line	:	BLDG. C
City	:	MANHATTAN
State	:	KS
Zip	:	66503-7601
Country	:	US
Telephone Number	:	785-539-3504
Fax Number	:	785-539-7430

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	01/03/2011

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