Individual
BENJAMIN IIAMES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6400 PASEO DEL NORTE BLVD NE, ALBUQUERQUE, NM 87113-1718
(505) 596-2100
Mailing address
PO BOX 26666, PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2021-0117
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/20/2019
Last updated
02/18/2022
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