Healthcare Provider Details

I. General information

NPI: 1386926798
Provider Name (Legal Business Name): MR. BEN S STEHOWER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2011
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 WHIPPLE ST STE A
PRESCOTT AZ
86301-1617
US

IV. Provider business mailing address

805 WHIPPLE ST STE A
PRESCOTT AZ
86301-1617
US

V. Phone/Fax

Practice location:
  • Phone: 928-533-5253
  • Fax: 928-777-9183
Mailing address:
  • Phone: 928-533-5253
  • Fax: 928-777-9183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number451060
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: