MEDICARE: DR. RICHARD P BENEDICT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	30435	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164412110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD P BENEDICT MD

Provider Business Mailing Address
First Line	:	5300 HIGHWAY 95
Second Line	:	STE K
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-9251
Country	:	US
Telephone Number	:	928-788-7000
Fax Number	:	928-788-9900

Provider Business Practice Location Address
First Line	:	5300 HIGHWAY 95
Second Line	:	STE K
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-9251
Country	:	US
Telephone Number	:	928-788-7000
Fax Number	:	928-788-9900

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	07/08/2007

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