Healthcare Provider Details

I. General information

NPI: 1316680457
Provider Name (Legal Business Name): BENTON LEE HURT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2022
Last Update Date: 08/04/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 I STREET BUIDLING 402
CAMP LEJEUNE NC
25847
US

IV. Provider business mailing address

165 I STREET HP402
CAMP LEJEUNE NC
28547
US

V. Phone/Fax

Practice location:
  • Phone: 910-449-8846
  • Fax:
Mailing address:
  • Phone: 615-761-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number0102208072
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102208072
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: