Healthcare Provider Details

I. General information

NPI: 1588308126
Provider Name (Legal Business Name): MATTHEW QUINN BENSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 E 23RD ST
CHEYENNE WY
82001-3748
US

IV. Provider business mailing address

214 E 23RD ST
CHEYENNE WY
82001-3748
US

V. Phone/Fax

Practice location:
  • Phone: 307-633-7900
  • Fax:
Mailing address:
  • Phone: 307-633-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberTL9157
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: