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General NPI Number Information
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NPI Number | 1790204824
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Entity Type | Individual
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Provider Name | BENJAMIN W SPEICHER PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/09/2017
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Last Update Date | 04/26/2021
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Provider Practice Location Address
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Address Line | 2175 ROSALINE AVE
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City | REDDING
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State | CA
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Zip | 96001-2549
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Country | US
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Telephone | 530-225-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 310 SUNNYVIEW LN
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City | KALISPELL
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State | MT
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Zip | 59901-3129
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Country | US
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Telephone | 406-752-5111
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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 | 54859
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License Number State | CA
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