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General NPI Number Information
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NPI Number | 1134574056
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Entity Type | Organization
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Legal Business Name | QUEEN CITY UROLOGY
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Dates
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Enumeration Date | 04/28/2016
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Last Update Date | 04/28/2016
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Provider Practice Location Address
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Address Line | 500 N LEWIS ST SUITE 270
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City | NEW IBERIA
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State | LA
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Zip | 70563-2046
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Country | US
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Telephone | 337-352-2210
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Fax |
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Provider Business Mailing Address
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Address Line | 500 N LEWIS ST SUITE 270
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City | NEW IBERIA
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State | LA
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Zip | 70563-2046
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Country | US
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Telephone | 337-352-2210
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID CALMON BENSON
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Credential | MD
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Telephone | 337-352-2210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 016565
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License Number State | LA
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