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General NPI Number Information
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NPI Number | 1194724211
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Entity Type | Individual
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Provider Name | ROBERT E BENEDETT MD
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Gender | Male
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Dates
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Enumeration Date | 07/20/2005
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Last Update Date | 12/20/2014
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Provider Practice Location Address
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Address Line | 1230 E KINGSLEY ST SUITE A
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City | SPRINGFIELD
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State | MO
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Zip | 65804-7211
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Country | US
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Telephone | 417-720-4916
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Fax | 417-720-4917
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Provider Business Mailing Address
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Address Line | 1230 E KINGSLEY ST SUITE A
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City | SPRINGFIELD
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State | MO
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Zip | 65804-7211
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Country | US
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Telephone | 417-720-4916
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Fax | 417-720-4917
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | R3K52
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License Number State | MO
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