Provider Demographics
NPI:1033181326
Name:BENFIELD, RODD JASON (MD)
Entity Type:Individual
Prefix:DR
First Name:RODD
Middle Name:JASON
Last Name:BENFIELD
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 1:1727 PETRA DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-5739
Mailing Address - Country:US
Mailing Address - Phone:619-985-8010
Mailing Address - Fax:
Practice Address - Street 1:4585 BERMUDA AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-3835
Practice Address - Country:US
Practice Address - Phone:619-532-7579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101224453208600000X
IN01051897A208600000X
CAC52420208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery