Basic Information
| Provider Information | |||||||||
| NPI: | 1295841914 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SONNICHSEN | ||||||||
| FirstName: | BEN | ||||||||
| MiddleName: | WILLIAMS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 190 | ||||||||
| Address2: | |||||||||
| City: | TOPPENISH | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989480190 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098655898 | ||||||||
| FaxNumber: | 5098653148 | ||||||||
| Practice Location | |||||||||
| Address1: | 820 MEMORIAL STREET | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | PROSSER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993502504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5097862010 | ||||||||
| FaxNumber: | 5097881794 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2006 | ||||||||
| LastUpdateDate: | 12/05/2011 | ||||||||
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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 | 207Q00000X | MD00017164 | WA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD00029197 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1585801 | 05 | WA | MEDICAID | 9392SO | 01 | WA | REGENCE | OTHER | 911019392 | 01 | COMMERCIAL | OTHER | 0200685 | 01 | WA | L & I | OTHER | 1306897681 | 01 | NPI PROSSER MEMORIAL | OTHER | 1585801 | 01 | WA | CHPW | OTHER |