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General NPI Number Information
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NPI Number | 1730281619
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Entity Type | Individual
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Provider Name | DOUGLAS J BENTON DO
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Gender | Male
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Dates
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Enumeration Date | 09/02/2006
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Last Update Date | 11/10/2008
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Provider Practice Location Address
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Address Line | 6092 FENTON RD
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City | FLINT
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State | MI
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Zip | 48507-4761
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Country | US
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Telephone | 810-239-4697
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Fax | 810-239-4553
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Provider Business Mailing Address
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Address Line | G-6092 FENTON RD
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City | FLINT
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State | MI
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Zip | 48507
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Country | US
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Telephone | 810-239-4697
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Fax | 810-239-4553
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101008533
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License Number State | MI
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