Healthcare Provider Details

I. General information

NPI: 1114419355
Provider Name (Legal Business Name): DOUGLAS MARTIN BENNION MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

IV. Provider business mailing address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 319-384-8277
  • Fax: 319-356-4547
Mailing address:
  • Phone: 319-384-8277
  • Fax: 319-356-4547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberMD-54602
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number103385
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD-54602
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: