MEDICARE: RAY E BENSON III D.O.

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	2083X0100X	Occupational Medicine Physician	34005107	OH

General Provider Information

NPI Number	:	1639291123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAY E BENSON III D.O.

Provider Business Mailing Address
First Line	:	5080 SPECTRUM DR
Second Line	:	SUITE 1200 WEST
City	:	ADDISON
State	:	TX
Zip	:	75001-4648
Country	:	US
Telephone Number	:	972-364-8000
Fax Number	:	214-775-4502

Provider Business Practice Location Address
First Line	:	1450 FIRESTONE PKWY
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44301-1655
Country	:	US
Telephone Number	:	330-724-3345
Fax Number	:

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

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	11/30/2011

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