Provider Demographics
NPI:1124025564
Name:BENJAMIN, SCOTT MCCLARREN (DPM)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:MCCLARREN
Last Name:BENJAMIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2667 FOX POINTE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-3222
Mailing Address - Country:US
Mailing Address - Phone:812-378-5800
Mailing Address - Fax:812-378-5808
Practice Address - Street 1:2667 FOX POINTE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203
Practice Address - Country:US
Practice Address - Phone:812-378-5800
Practice Address - Fax:812-378-5808
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000853A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200529100AMedicaid
U56707Medicare UPIN
IN200529100AMedicaid
IN252780AMedicare PIN
INU56707Medicare UPIN