Provider Demographics
NPI:1336727627
Name:WATZIG, BENJAMIN FRANCIS GENE (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:FRANCIS GENE
Last Name:WATZIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16870 SE ROCK CREEK CT
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-6761
Mailing Address - Country:US
Mailing Address - Phone:503-318-7932
Mailing Address - Fax:
Practice Address - Street 1:755 E MCDOWELL RD FL 2
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2506
Practice Address - Country:US
Practice Address - Phone:602-521-3250
Practice Address - Fax:602-521-3251
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program