| Doctor Name: | DR. BENJAMIN G DIVEN |
| NPI Number: | 1538276142 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 8234 |
| Business Practice Address: | Corner Of Stewart And Breland Student Health Center, Box 30001 Msc 3529 Las Cruces, NM - 88003 |
| Business Phone Number: | 5056468308 |
| Business Fax Number: | 5056466428 |
| Mailing Address: | Corner Of Stewart And Breland, Student Health Center, Box 30001 Msc 3529 LAS CRUCES |
| State: | NM |
| Postal Code: | 88003 |
| Phone Number: | 5056468308 |
| Fax Number: | 5056466428 |
| NPI Enumeration Date: | 08/23/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 8234 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |