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General NPI Number Information
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NPI Number | 1730306200
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Entity Type | Individual
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Provider Name | ANDRE WILLIAM BENSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 03/29/2016
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Provider Practice Location Address
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Address Line | 7720 WASHINGTON ST SUITE 103
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City | PORT RICHEY
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State | FL
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Zip | 34668-6553
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Country | US
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Telephone | 813-278-0020
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Fax |
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Provider Business Mailing Address
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Address Line | 9408 APPLE VALLEY DR
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City | WEEKI WACHEE
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State | FL
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Zip | 34613-3418
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Country | US
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Telephone | 813-310-8544
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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 | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | ME23061
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License Number State | FL
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