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General NPI Number Information
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NPI Number | 1619104130
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Entity Type | Individual
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Provider Name | BRADLEY VERNON BENSON D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/11/2009
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 1001 WILLOW CREEK RD STE 3100
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City | PRESCOTT
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State | AZ
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Zip | 86301-1614
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Country | US
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Telephone | 928-445-4818
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Fax | 928-445-4837
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Provider Business Mailing Address
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Address Line | PO BOX 10880
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City | PRESCOTT
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State | AZ
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Zip | 86304-0880
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Country | US
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Telephone | 602-406-4786
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Fax | 916-636-4358
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 005884
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License Number State | AZ
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