Provider Demographics
NPI:1073780011
Name:MONTEREY BAY UROLOGY ASSOCIATES
Entity Type:Organization
Organization Name:MONTEREY BAY UROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:BENJAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-728-4227
Mailing Address - Street 1:160 GREEN VALLEY RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FREEDOM
Mailing Address - State:CA
Mailing Address - Zip Code:95019-3160
Mailing Address - Country:US
Mailing Address - Phone:831-728-4227
Mailing Address - Fax:831-728-0410
Practice Address - Street 1:1575 SOQUEL DR
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1700
Practice Address - Country:US
Practice Address - Phone:831-476-2626
Practice Address - Fax:831-476-3355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75256 PARTNER208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0083650Medicaid
CN6663Medicare PIN
ZZZ15543ZMedicare PIN