Individual
DR. BENJAMIN EARL BRACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Contact information
Practice address
333 1ST ST STE A, SAN FRANCISCO, CA 94105-2661
(415) 840-0560
Mailing address
333 1ST ST STE A, SAN FRANCISCO, CA 94105-2661
(415) 840-0560
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085.007821
IL
363A00000X
Physician Assistant
36677
MT
363A00000X
Physician Assistant
58410
CA
363A00000X
Physician Assistant
MA063553
PA
363A00000X
Physician Assistant
Primary
PA05586
TX
363A00000X
Physician Assistant
PA2018-0030
NM
363A00000X
Physician Assistant
PA61278699
WA
363A00000X
Physician Assistant
PA7893
MA
363A00000X
Physician Assistant
PA9112434
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1959926-01
—
TX
05
—
195992602
—
TX
05
—
195992603
—
TX
05
—
195992604
—
TX
05
—
PENDING
—
TX
Enumeration date
02/11/2008
Last updated
10/28/2022
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