Provider Demographics
NPI:1730184003
Name:BENOIT, GENA LR (MD)
Entity type:Individual
Prefix:
First Name:GENA
Middle Name:LR
Last Name:BENOIT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GENA
Other - Middle Name:LR
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:865 LINCOLN RD
Mailing Address - Street 2:STE L10
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-4159
Mailing Address - Country:US
Mailing Address - Phone:563-355-9191
Mailing Address - Fax:563-355-3419
Practice Address - Street 1:1345 W CENTRAL PARK AVE
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804-1844
Practice Address - Country:US
Practice Address - Phone:563-421-4400
Practice Address - Fax:563-421-4449
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA33633207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4796890003OtherDMERC
IA01C8OtherJOHN DEERE HEALTH PLAN
080185468OtherRAILROAD MEDICARE
077432OtherHEALTH ALLIANCE
IA3192799Medicaid
143695OtherIOWA HEALTH SOLUTIONS
IA55817OtherWELLMARK HEALTH PLANS
143695OtherIOWA HEALTH SOLUTIONS