Healthcare Provider Details

I. General information

NPI: 1821749391
Provider Name (Legal Business Name): BENJAMIN JOHNATHAN TSCHUDY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2022
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 N ROADRUNNER PKWY STE 228
LAS CRUCES NM
88011-2001
US

IV. Provider business mailing address

7300 RANCH ROAD 2222, BLDG 1, STE 200
AUSTIN TX
78730-3255
US

V. Phone/Fax

Practice location:
  • Phone: 575-521-1177
  • Fax:
Mailing address:
  • Phone: 512-759-8932
  • Fax: 512-233-2711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: