Healthcare Provider Details

I. General information

NPI: 1376506725
Provider Name (Legal Business Name): NORMAN BENSKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 12/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38883 HIGHWAY 299
WILLOW CREEK CA
95573-0726
US

IV. Provider business mailing address

PO BOX 726
WILLOW CREEK CA
95573-0726
US

V. Phone/Fax

Practice location:
  • Phone: 530-629-3111
  • Fax: 530-629-3122
Mailing address:
  • Phone: 530-629-3111
  • Fax: 530-629-3122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG54910
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG54910
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: