Provider Demographics
NPI:1033141585
Name:BENSEN, RANDAL D (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDAL
Middle Name:D
Last Name:BENSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 661539
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91066-1539
Mailing Address - Country:US
Mailing Address - Phone:626-447-0296
Mailing Address - Fax:626-447-6057
Practice Address - Street 1:2005 NW SAMMAMISH RD
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5364
Practice Address - Country:US
Practice Address - Phone:425-394-0610
Practice Address - Fax:425-394-0809
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00025068207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8117855Medicaid
WA8862727Medicare PIN
WAC13369Medicare UPIN