Provider Demographics
NPI:1093703035
Name:BENSON, DAVID C (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:BENSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:BENSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2000 CANAL ST FL 5
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-3018
Mailing Address - Country:US
Mailing Address - Phone:504-702-4333
Mailing Address - Fax:
Practice Address - Street 1:2000 CANAL ST FL 5
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-3018
Practice Address - Country:US
Practice Address - Phone:504-702-4333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016565208800000X
KY25096208800000X
IN01035659A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN340003585OtherRR MCR
KYP00242544OtherRR MCR
KY64758030Medicaid
IN100362160Medicaid
LA1884073Medicaid
C69228Medicare UPIN
LA1884073Medicaid
LA1165003Medicare PIN
IN100362160Medicaid