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1730184003

NPI Code Detail

MEDICARE: GENA L.R. BENOIT MD

MEDICARE: GENA L.R. BENOIT 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	207Q00000X	Family Medicine Physician	33633	IA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	080185468	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4796890003	OTHER		DMERC
2	IA01C8	OTHER		JOHN DEERE HEALTH PLAN
4	077432	OTHER		HEALTH ALLIANCE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	143695	OTHER		IOWA HEALTH SOLUTIONS
7	55817	OTHER	IA	WELLMARK HEALTH PLANS

General Provider Information

NPI Number	:	1730184003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENA L.R. BENOIT MD

Provider Business Mailing Address
First Line	:	865 LINCOLN RD
Second Line	:	STE L10
City	:	BETTENDORF
State	:	IA
Zip	:	52722-4159
Country	:	US
Telephone Number	:	563-355-9191
Fax Number	:	563-355-3419

Provider Business Practice Location Address
First Line	:	1345 W CENTRAL PARK AVE
Second Line	:
City	:	DAVENPORT
State	:	IA
Zip	:	52804-1844
Country	:	US
Telephone Number	:	563-421-4400
Fax Number	:	563-421-4449

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	04/20/2021

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Directions to “ GENA L.R. BENOIT MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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