Healthcare Provider Details

I. General information

NPI: 1063588812
Provider Name (Legal Business Name): BENJAMIN MONSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL LN STE 325
DANVILLE IN
46122-1993
US

IV. Provider business mailing address

4700 LAS VEGAS BLVD N
NELLIS AFB NV
89191-6600
US

V. Phone/Fax

Practice location:
  • Phone: 317-718-7980
  • Fax: 317-718-7918
Mailing address:
  • Phone: 702-653-3050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number14555
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: