Provider Demographics
NPI:1164477618
Name:BENSON, DALTON M (MD)
Entity Type:Individual
Prefix:
First Name:DALTON
Middle Name:M
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 1:5400 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-3833
Mailing Address - Country:US
Mailing Address - Phone:352-277-5348
Mailing Address - Fax:352-606-2857
Practice Address - Street 1:3480 DELTONA BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-2917
Practice Address - Country:US
Practice Address - Phone:352-600-7900
Practice Address - Fax:352-600-8994
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59864207RG0300X, 208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370999000Medicaid
FL14670OtherBLUE CROSS BLUE SHIELD
FL370999000Medicaid
FL14670PMedicare PIN
FL14670OMedicare PIN
FL14670LMedicare PIN
FL14670KMedicare PIN