MEDICARE: BENJAMIN MARTIN PA-S2

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
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1497633382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN MARTIN PA-S2

Provider Business Mailing Address
First Line	:	21817 N 33RD AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85027-1680
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21817 N 33RD AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85027-1680
Country	:	US
Telephone Number	:	602-402-3681
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2025
Last Update Date	:	08/26/2025

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Directions to “ BENJAMIN MARTIN PA-S2” Practice Location

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