MEDICARE: DR. TRAVIS BENSON 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	207N00000X	Dermatology Physician	MD70005305	WA

General Provider Information

NPI Number	:	1366191140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRAVIS BENSON MD

Provider Business Mailing Address
First Line	:	18209 SR 410 E STE 100
Second Line	:
City	:	BONNEY LAKE
State	:	WA
Zip	:	98391-5146
Country	:	US
Telephone Number	:	253-848-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	18209 SR 410 E STE 100
Second Line	:
City	:	BONNEY LAKE
State	:	WA
Zip	:	98391-5146
Country	:	US
Telephone Number	:	253-848-3000
Fax Number	:

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

Provider Enumeration Date	:	03/21/2022
Last Update Date	:	05/26/2026

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