Healthcare Provider Details

I. General information

NPI: 1811004245
Provider Name (Legal Business Name): MARK RICHARD BENFIELD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 05/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 PARKVIEW DRIVE NE
CULLMAN AL
35058-3618
US

IV. Provider business mailing address

1801 PARKVIEW DRIVE NE
CULLMAN AL
35058-3618
US

V. Phone/Fax

Practice location:
  • Phone: 205-558-3200
  • Fax: 205-623-1090
Mailing address:
  • Phone: 205-558-3200
  • Fax: 205-623-1090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number12284
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier000015888
Identifier TypeMEDICAID
Identifier StateAL
Identifier Issuer
# 2
Identifier000028811
Identifier TypeMEDICAID
Identifier StateAL
Identifier Issuer
# 3
Identifier122391
Identifier TypeMEDICAID
Identifier StateAL
Identifier Issuer
# 4
Identifier0120252
Identifier TypeMEDICAID
Identifier StateMS
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: