Healthcare Provider Details

I. General information

NPI: 1639291123
Provider Name (Legal Business Name): RAY E BENSON III D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 FIRESTONE PKWY
AKRON OH
44301-1655
US

IV. Provider business mailing address

5080 SPECTRUM DR SUITE 1200 WEST
ADDISON TX
75001-4648
US

V. Phone/Fax

Practice location:
  • Phone: 330-724-3345
  • Fax:
Mailing address:
  • Phone: 972-364-8000
  • Fax: 214-775-4502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number34005107
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: