Healthcare Provider Details

I. General information

NPI: 1295841914
Provider Name (Legal Business Name): BEN WILLIAMS SONNICHSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 MEMORIAL STREET SUITE 1
PROSSER WA
99350-2504
US

IV. Provider business mailing address

PO BOX 190
TOPPENISH WA
98948-0190
US

V. Phone/Fax

Practice location:
  • Phone: 509-786-2010
  • Fax: 509-788-1794
Mailing address:
  • Phone: 509-865-5898
  • Fax: 509-865-3148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00017164
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00029197
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: