Healthcare Provider Details

I. General information

NPI: 1386209146
Provider Name (Legal Business Name): BENJAMIN MCKINNLEY HOWARD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 37TH AVE SW
MINOT ND
58701-7669
US

IV. Provider business mailing address

1000 N LEE AVE RM 1980
OKLAHOMA CITY OK
73102-1036
US

V. Phone/Fax

Practice location:
  • Phone: 701-418-8000
  • Fax:
Mailing address:
  • Phone: 405-272-8437
  • Fax: 405-231-3007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number9006
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberV1486
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberPT21897
License Number StateND
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number20A23507
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: