Healthcare Provider Details

I. General information

NPI: 1417701384
Provider Name (Legal Business Name): BEN KHALIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 NE A ST
MADRAS OR
97741-1844
US

IV. Provider business mailing address

PO BOX 6095
BEND OR
97708-6095
US

V. Phone/Fax

Practice location:
  • Phone: 541-475-4800
  • Fax:
Mailing address:
  • Phone: 541-706-5922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPG227430
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: