Basic Information
| Provider Information | |||||||||
| NPI: | 1407064009 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAMPHERE | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | GORDON | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 107 | ||||||||
| Address2: | |||||||||
| City: | TRAVERSE CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 496850107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2319229270 | ||||||||
| FaxNumber: | 2319229271 | ||||||||
| Practice Location | |||||||||
| Address1: | 1105 SIXTH ST | ||||||||
| Address2: | |||||||||
| City: | TRAVERSE CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 496842345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2319355000 | ||||||||
| FaxNumber: | 2313960622 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2007 | ||||||||
| LastUpdateDate: | 07/01/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301094058 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 4301094058 | MI | N | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.