Provider Demographics
NPI:1124151725
Name:MALTZ, BEN RAY (MD)
Entity type:Individual
Prefix:DR
First Name:BEN
Middle Name:RAY
Last Name:MALTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10TH CST WMD
Mailing Address - Street 2:BUILDING 6
Mailing Address - City:CAMP MURRAY
Mailing Address - State:WA
Mailing Address - Zip Code:98430-0001
Mailing Address - Country:US
Mailing Address - Phone:253-512-8424
Mailing Address - Fax:253-512-8116
Practice Address - Street 1:10TH CST WMD
Practice Address - Street 2:BUILDING 6
Practice Address - City:CAMP MURRAY
Practice Address - State:WA
Practice Address - Zip Code:98430-0001
Practice Address - Country:US
Practice Address - Phone:253-512-8424
Practice Address - Fax:253-512-8116
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00030505207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine