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General NPI Number Information
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NPI Number | 1679259980
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Entity Type | Individual
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Provider Name | BENJAMIN MITCHELL SMITH PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/22/2023
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Last Update Date | 08/23/2023
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Provider Practice Location Address
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Address Line | 10401 W THUNDERBIRD BLVD
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City | SUN CITY
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State | AZ
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Zip | 85351-3004
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Country | US
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Telephone | 623-832-5366
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Fax | 623-832-7520
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Provider Business Mailing Address
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Address Line | 20000 N 57TH AVE RM G205
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City | GLENDALE
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State | AZ
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Zip | 85308-6872
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Country | US
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Telephone | 845-249-8069
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9760
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License Number State | AZ
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