Healthcare Provider Details

I. General information

NPI: 1760653125
Provider Name (Legal Business Name): BENSTON DANIEL JOHNSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12310 CRESTRIDGE LOOP
TRINITY FL
34655-0028
US

IV. Provider business mailing address

12310 CRESTRIDGE LOOP
TRINITY FL
34655-0028
US

V. Phone/Fax

Practice location:
  • Phone: 727-373-8678
  • Fax:
Mailing address:
  • Phone: 727-373-8678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS10941
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A23807
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberW0055
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number247867
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: