MEDICARE: JEFF A BENJAMIN DO

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	2084N0400X	Neurology Physician	0501	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2023740	OTHER	SC	EVOLUTIONS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1061000	OTHER	WV	WORK COMP
4	3099820	OTHER	SC	GHI
5	434035	OTHER	SC	ONE HEALTH PLAN
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	A156	OTHER	NC	NC UHC
8	1189849	OTHER	SC	FIRST HEALTH
9	7251177	OTHER	SC	AETNA
10	82645	OTHER	SC	MEDCOST
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	0504464	OTHER	SC	PHP
13	521523	OTHER	SC	FOCUS HEALTHCARE

General Provider Information

NPI Number	:	1821057779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFF A BENJAMIN DO

Provider Business Mailing Address
First Line	:	8170 ROURK STREET
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29572-4127
Country	:	US
Telephone Number	:	843-449-2336
Fax Number	:	843-479-2505

Provider Business Practice Location Address
First Line	:	8170 ROURK ST
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29572-4127
Country	:	US
Telephone Number	:	843-449-2336
Fax Number	:	843-497-2505

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

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	10/14/2011

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Directions to “ JEFF A BENJAMIN DO” Practice Location

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