Individual
BENJAMIN M STAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1115 CENTRAL AVE NE, PMG EMERGENCY MEDICINE, ALBUQUERQUE, NM 87106-4927
(505) 841-1125
(505) 841-1737
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-5356
(505) 923-5654
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
93160
NM
Other
Enumeration date
10/03/2006
Last updated
07/15/2008
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