MEDICARE: SCOTT D BENNION M.D.

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	34844	CO
2	207N00000X	Dermatology Physician	3201A	WY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	070014069	OTHER	WY	MEDICARE RAILROAD

Other Identifiers

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

General Provider Information

NPI Number	:	1952317505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT D BENNION M.D.

Provider Business Mailing Address
First Line	:	2546 E 2ND ST STE 400
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82609-2062
Country	:	US
Telephone Number	:	307-234-0003
Fax Number	:

Provider Business Practice Location Address
First Line	:	2546 E 2ND ST STE 400
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82609-2062
Country	:	US
Telephone Number	:	307-234-0003
Fax Number	:

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	10/15/2012

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Directions to “ SCOTT D BENNION M.D.” Practice Location

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