Provider Demographics
NPI:1063474518
Name:BENSON, SCOTT JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:JOSEPH
Last Name:BENSON
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 1:200 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905-0001
Mailing Address - Country:US
Mailing Address - Phone:507-377-6285
Mailing Address - Fax:
Practice Address - Street 1:32021 COUNTY 24 BLVD
Practice Address - Street 2:
Practice Address - City:CANNON FALLS
Practice Address - State:MN
Practice Address - Zip Code:55009-5003
Practice Address - Country:US
Practice Address - Phone:507-377-6285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45662207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN431T7BEOtherBLUE CROSS BLUE SHIELD
MN6607467OtherMEDICA URGENT CARE
MNNA4431034911OtherPREFERREDONE
MN418911600Medicaid
MN0121330OtherMEDICA - CLINIC
MNHP39649OtherHEALTHPARTNERS
MNP00229573Medicare ID - Type UnspecifiedMEDICARE RAILROAD