MEDICARE: DR. RODD JASON BENFIELD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	0101224453	VA
2	208600000X	Surgery Physician	01051897A	IN
3	208600000X	Surgery Physician	C52420	CA

General Provider Information

NPI Number	:	1033181326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RODD JASON BENFIELD MD

Provider Business Mailing Address
First Line	:	1727 PETRA DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-5739
Country	:	US
Telephone Number	:	619-985-8010
Fax Number	:

Provider Business Practice Location Address
First Line	:	4585 BERMUDA AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92107-3835
Country	:	US
Telephone Number	:	619-532-7579
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	10/19/2017

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