Provider Demographics
NPI:1538276142
Name:DIVEN, BENJAMIN G (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:G
Last Name:DIVEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:CORNER OF STEWART AND BRELAND
Mailing Address - Street 2:STUDENT HEALTH CENTER, BOX 30001 MSC 3529
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88003
Mailing Address - Country:US
Mailing Address - Phone:505-646-8308
Mailing Address - Fax:505-646-6428
Practice Address - Street 1:CORNER OF STEWART AND BRELAND
Practice Address - Street 2:STUDENT HEALTH CENTER, BOX 30001 MSC 3529
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88003
Practice Address - Country:US
Practice Address - Phone:505-646-8308
Practice Address - Fax:505-646-6428
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM8234208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice