Healthcare Provider Details

I. General information

NPI: 1205811197
Provider Name (Legal Business Name): BETH B BENSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 05/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 2ND AVE SW
LARGO FL
33770-3120
US

IV. Provider business mailing address

1301 2ND AVE SW
LARGO FL
33770-3120
US

V. Phone/Fax

Practice location:
  • Phone: 727-584-7706
  • Fax: 727-581-9101
Mailing address:
  • Phone: 727-584-7706
  • Fax: 727-581-9101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME0040289
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: