Healthcare Provider Details

I. General information

NPI: 1518951201
Provider Name (Legal Business Name): DANIEL JAMES BENSON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 SPRUCE ST SUITE #5
AUGUSTA ME
04330-5204
US

IV. Provider business mailing address

58 CROSS RD
SOUTH CHINA ME
04358-4007
US

V. Phone/Fax

Practice location:
  • Phone: 207-626-0100
  • Fax: 207-626-0800
Mailing address:
  • Phone: 207-626-0100
  • Fax: 207-626-0800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPOD1012
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: