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NPI Code Detail

MEDICARE: BRIAN BENSON DPM

MEDICARE: BRIAN BENSON DPM
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
1213E00000XPodiatrist326824LA
2213ES0103XFoot & Ankle Surgery PodiatristPOD001453GA
3213ES0103XFoot & Ankle Surgery Podiatrist326864LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104350883
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN BENSON DPM
Provider Business Mailing Address
First Line : PO BOX 730
Second Line :
City : DERIDDER
State : LA
Zip : 70634-0730
Country : US
Telephone Number : 337-239-1061
Fax Number :
Provider Business Practice Location Address
First Line : 1108 PORT ARTHUR TER
Second Line :
City : LEESVILLE
State : LA
Zip : 71446-4600
Country : US
Telephone Number : 337-239-1061
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2017
Last Update Date : 07/28/2021

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