Provider Demographics
NPI:1225220320
Name:SIGMOND, BENJAMIN R (MD, CWS)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:R
Last Name:SIGMOND
Suffix:
Gender:M
Credentials:MD, CWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 PARK ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1708
Mailing Address - Country:US
Mailing Address - Phone:270-781-5111
Mailing Address - Fax:
Practice Address - Street 1:1325 ANDREA ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-5852
Practice Address - Country:US
Practice Address - Phone:270-783-3306
Practice Address - Fax:270-780-0491
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP279208600000X
KY59883208600000X
PAMD427801208600000X
TXP0497208600000X
OH35099820208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0076920Medicaid
OH0076920Medicaid