Provider Demographics
NPI:1235516675
Name:HEGENBARTH, BENJAMIN J (DO)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:J
Last Name:HEGENBARTH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:39000 BOB HOPE DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3221
Mailing Address - Country:US
Mailing Address - Phone:760-340-3911
Mailing Address - Fax:
Practice Address - Street 1:72780 COUNTRY CLUB DR STE 203
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4150
Practice Address - Country:US
Practice Address - Phone:760-834-3593
Practice Address - Fax:760-674-3845
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-06
Last Update Date:2025-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ007738207Q00000X
CA20A24667207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ007738OtherMEDICAL LICENSE
FH5441023OtherDEA