Individual
BENJMAMIN THOMAS CARLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
5314 N 7TH ST, PHOENIX, AZ 85014-2805
(602) 277-5006
Mailing address
1157 E WATSON DR, TEMPE, AZ 85283-3034
Taxonomy
Speciality
Code
Description
License number
State
2080P0008X
Pediatric Neurodevelopmental Disabilities Physician
Primary
13747
AZ
Other
Enumeration date
05/01/2018
Last updated
05/01/2018
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