Individual
BENJAMIN RUSSELL BACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
7062 HIGHLANDS LN, TYLER, TX 75703-0590
(903) 483-1090
Mailing address
13025 PRELUDE DR, FRISCO, TX 75035-2224
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA11467
TX
Other
Enumeration date
10/08/2017
Last updated
10/08/2017
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