Healthcare Provider Details

I. General information

NPI: 1376703454
Provider Name (Legal Business Name): BRENT JASON BENSCOTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 EXPOSITION BLVD BLDG 700
SACRAMENTO CA
95815-4314
US

IV. Provider business mailing address

1111 EXPOSITION BLVD BLDG 700
SACRAMENTO CA
95815-4314
US

V. Phone/Fax

Practice location:
  • Phone: 916-736-3399
  • Fax: 916-233-4171
Mailing address:
  • Phone: 916-736-3399
  • Fax: 916-736-3350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number125053418
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number4301099963
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number01073373A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberA150679
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: