Provider Demographics
NPI:1619944527
Name:BENSON, NEIL F (MD)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:F
Last Name:BENSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 N. PALM AVE.
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-2626
Mailing Address - Country:US
Mailing Address - Phone:386-325-9008
Mailing Address - Fax:
Practice Address - Street 1:108 N. PALM AVE.
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-2626
Practice Address - Country:US
Practice Address - Phone:386-325-9008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044398207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A13289Medicare UPIN
FL02559ZMedicare ID - Type Unspecified