Healthcare Provider Details

I. General information

NPI: 1689669475
Provider Name (Legal Business Name): DONALD JOHN BENZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 N DEVINE RD STE B
VANCOUVER WA
98661-6979
US

IV. Provider business mailing address

18 NW 20TH AVE
BATTLE GROUND WA
98604-4175
US

V. Phone/Fax

Practice location:
  • Phone: 360-952-4457
  • Fax: 360-828-7409
Mailing address:
  • Phone: 360-952-4457
  • Fax: 360-828-7409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00016331
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: