Healthcare Provider Details

I. General information

NPI: 1922038348
Provider Name (Legal Business Name): PAUL ANDREW SCOTT BENSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 10/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 E. 41ST STREET, 2ND FLOOR OU PHYSICIANS -- PEDIATRICS
TULSA OK
74135
US

IV. Provider business mailing address

4502 E. 41ST STREET, ROOM 2A41 OU-TULSA SCHOOL OF COMMUNITY MEDICINE
TULSA OK
74135
US

V. Phone/Fax

Practice location:
  • Phone: 918-660-3400
  • Fax: 918-660-3410
Mailing address:
  • Phone: 918-660-3400
  • Fax: 918-660-3410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number35088035
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number30099
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: