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NPI Code Detail

MEDICARE: BENJAMIN WIEST BARLOW PHYSICIAN ASSISTANT

MEDICARE: BENJAMIN WIEST BARLOW PHYSICIAN ASSISTANT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician AssistantPA18160TX

General Provider Information

NPI Number : 1245884824
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENJAMIN WIEST BARLOW PHYSICIAN ASSISTANT
Provider Business Mailing Address
First Line : 12324 DESERT HEIGHTS CT
Second Line :
City : EL PASO
State : TX
Zip : 79938-2418
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 18511 HIGHLANDER MEDICS ST
Second Line :
City : FORT BLISS
State : TX
Zip : 79906-5327
Country : US
Telephone Number : 915-569-3425
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2019
Last Update Date : 01/21/2026

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