Provider Demographics
NPI:1306505201
Name:WRENCH, BENJAMIN HILDRETH
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:HILDRETH
Last Name:WRENCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1733 SW PEMBROKE LN
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-3258
Mailing Address - Country:US
Mailing Address - Phone:785-817-6720
Mailing Address - Fax:
Practice Address - Street 1:1733 SW PEMBROKE LN
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-3258
Practice Address - Country:US
Practice Address - Phone:785-817-6720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-80674-111207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine