Provider Demographics
NPI:1730306200
Name:BENSON, ANDRE WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:WILLIAM
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 1:9408 APPLE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:WEEKI WACHEE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-3418
Mailing Address - Country:US
Mailing Address - Phone:813-310-8544
Mailing Address - Fax:
Practice Address - Street 1:7720 WASHINGTON ST
Practice Address - Street 2:SUITE 103
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-6553
Practice Address - Country:US
Practice Address - Phone:813-278-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME23061207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376961501Medicaid
FLD61599Medicare UPIN