Individual
MR. BENJAMIN DALE PROHASKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
10085 DOUBLE R BLVD, STE 310, RENO, NV 89521
(775) 982-7260
(775) 982-7268
Mailing address
5444 RENO CORPORATE DR, RENO, NV 89511-2250
(775) 786-6770
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA943
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12780456
CAQH
—
01
—
P00426676
RAILROAD MEDICARE
NV
Enumeration date
03/05/2007
Last updated
01/18/2022
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