Provider Demographics
NPI:1609116144
Name:SAM, BENJAMIN SITHEN (PA)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:SITHEN
Last Name:SAM
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 S FM 1626
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-9432
Mailing Address - Country:US
Mailing Address - Phone:512-295-2437
Mailing Address - Fax:
Practice Address - Street 1:220 S FM 1626
Practice Address - Street 2:
Practice Address - City:BUDA
Practice Address - State:TX
Practice Address - Zip Code:78610-9432
Practice Address - Country:US
Practice Address - Phone:512-295-2437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-20
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08109363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant