Healthcare Provider Details

I. General information

NPI: 1952317505
Provider Name (Legal Business Name): SCOTT D BENNION M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 10/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2546 E 2ND ST STE 400
CASPER WY
82609-2062
US

IV. Provider business mailing address

2546 E 2ND ST STE 400
CASPER WY
82609-2062
US

V. Phone/Fax

Practice location:
  • Phone: 307-234-0003
  • Fax:
Mailing address:
  • Phone: 307-234-0003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number34844
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number3201A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: