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General NPI Number Information
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NPI Number | 1457542656
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Entity Type | Individual
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Provider Name | GERARD MARK BENECKI M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 11/25/2025
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Provider Practice Location Address
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Address Line | 121 N DIVISION ST STE 310
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City | AUBURN
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State | WA
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Zip | 98001-4931
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Country | US
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Telephone | 253-792-6555
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Fax | 253-833-1071
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Provider Business Mailing Address
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Address Line | 2037 NE GUSTAF ST
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City | POULSBO
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State | WA
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Zip | 98370-7322
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Country | US
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Telephone | 224-723-7774
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Fax |
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MD60866946
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | MD60866946
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License Number State | WA
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