Healthcare Provider Details

I. General information

NPI: 1013606169
Provider Name (Legal Business Name): BENJAMIN CLAUSSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 N. SCOTTSDALE RD. BLDG. 4, STE. 170
MESA AZ
85209-3767
US

IV. Provider business mailing address

3055 N RED MTN UNIT 153
MESA AZ
85207-1063
US

V. Phone/Fax

Practice location:
  • Phone: 480-358-6100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR4126
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: