Healthcare Provider Details

I. General information

NPI: 1538110366
Provider Name (Legal Business Name): MORRIS SCOTT BENSON P.A.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 NORTH 20TH STREET # 18
OPELIKA AL
36801-5457
US

IV. Provider business mailing address

121 NORTH 20TH STREET # 18 P.O. BOX 2125
OPELIKA AL
36803-2125
US

V. Phone/Fax

Practice location:
  • Phone: 334-749-8303
  • Fax: 334-745-5243
Mailing address:
  • Phone: 334-749-8303
  • Fax: 334-745-5243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA 210
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: