Basic Information
| Provider Information | |||||||||
| NPI: | 1215915194 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YABUT | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | SALAZAR | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 650 HUEBNER RD | ||||||||
| Address2: | |||||||||
| City: | FORT RILEY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 664424030 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 650 HUEBNER RD | ||||||||
| Address2: | |||||||||
| City: | FORT RILEY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 664424030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3163213300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2006 | ||||||||
| LastUpdateDate: | 09/09/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 04-44021 | KS | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | 0444021 | KS | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 01041325A | IN | N | Allopathic & Osteopathic Physicians | Pediatrics | 208D00000X | 0444021 | KS | N | Allopathic & Osteopathic Physicians | General Practice | 208000000X | 0444021 | KS | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 036-085422 | 05 | IL | MEDICAID | 0007055591 | 01 | AETNA | OTHER | 0001635078 | 01 | BLUE CROSS BLUE SHIELD OF ILLINOIS | OTHER |