Healthcare Provider Details

I. General information

NPI: 1841209848
Provider Name (Legal Business Name): BEN STRICKS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 SAINT MICHAELS DR
SANTA FE NM
87505-7601
US

IV. Provider business mailing address

5410 MARYLAND WAY SUITE
BRENTWOOD TN
37027-5064
US

V. Phone/Fax

Practice location:
  • Phone: 505-989-6130
  • Fax: 505-820-5408
Mailing address:
  • Phone: 615-377-5670
  • Fax: 615-377-1678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD20040053
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: