Healthcare Provider Details

I. General information

NPI: 1316947377
Provider Name (Legal Business Name): ROBERT SCOTT BENSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5190 BAYOU BLVD BLDG 6
PENSACOLA FL
32503-2194
US

IV. Provider business mailing address

5190 BAYOU BLVD BLDG 6
PENSACOLA FL
32503-2194
US

V. Phone/Fax

Practice location:
  • Phone: 850-476-0977
  • Fax: 850-476-2558
Mailing address:
  • Phone: 850-476-0977
  • Fax: 850-476-2558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number26830
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: