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NPI Code Detail

MEDICARE: BENJAMIN HOGAN CRENSHAW PA-C

MEDICARE: BENJAMIN HOGAN CRENSHAW PA-C
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
1363A00000XPhysician Assistant57207CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1Q00288120OTHERINRAILROAD MEDICARE

General Provider Information

NPI Number : 1447806542
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENJAMIN HOGAN CRENSHAW PA-C
Provider Business Mailing Address
First Line : 4100 TRUXTUN AVE STE 200
Second Line :
City : BAKERSFIELD
State : CA
Zip : 93309-0656
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4100 TRUXTUN AVE STE 200
Second Line :
City : BAKERSFIELD
State : CA
Zip : 93309-0656
Country : US
Telephone Number : 661-632-1540
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2019
Last Update Date : 07/08/2022

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Directions to “ BENJAMIN HOGAN CRENSHAW PA-C” Practice Location

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