Basic Information
| Provider Information | |||||||||
| NPI: | 1619266608 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAMBERTSON | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | DASHIELL | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 E 104TH ST | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641314517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162515200 | ||||||||
| FaxNumber: | 8162515299 | ||||||||
| Practice Location | |||||||||
| Address1: | 4801 S CLIFF AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | INDEPENDENCE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640556954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162515200 | ||||||||
| FaxNumber: | 8162515299 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2011 | ||||||||
| LastUpdateDate: | 04/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 57805 | MN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 2021037240 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.