Healthcare Provider Details

I. General information

NPI: 1700917002
Provider Name (Legal Business Name): EDWARD PERRY BENBOW III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1965 LIVE OAK BLVD
YUBA CITY CA
95991-8828
US

IV. Provider business mailing address

9954 MILLER LN
MARYSVILLE CA
95901-9401
US

V. Phone/Fax

Practice location:
  • Phone: 530-822-7200
  • Fax:
Mailing address:
  • Phone: 530-749-0439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG31543
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: