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Benjamin Waters Theisen, DO

Student in an Organized Health Care Education/Training Program in Little Rock, AR. Individual provider (NPI-1).

NPI number1235718529
StatusActive
Last updated in NPPESJun 27, 2024

Details

NPI
1235718529
Entity type
Individual (NPI-1)
Name
Benjamin Waters Theisen
Credential
DO
Sex
Male
Sole proprietor
Yes
Enumeration date
Apr 5, 2021
Certification date
Jun 27, 2024
Last updated
Jun 27, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
390200000X Student in an Organized Health Care Education/Training Program––Yes

Practice location

1 Childrens Way # 512-19a
Little Rock, AR 72202-3500

Phone 501-364-1874

Mailing address

1 Childrens Way # 512-3
Little Rock, AR 72202-3500

Phone 501-364-2012

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