Provider Demographics
NPI:1174509228
Name:BEBENSEE, JEFFREY L (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:L
Last Name:BEBENSEE
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 1:4631 MERLE HAY RD
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50322-1962
Mailing Address - Country:US
Mailing Address - Phone:515-278-0949
Mailing Address - Fax:515-278-6721
Practice Address - Street 1:4631 MERLE HAY RD
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50322-1962
Practice Address - Country:US
Practice Address - Phone:515-278-0949
Practice Address - Fax:515-278-6721
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA27643207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3057620Medicaid
IA4057620Medicaid
IA5057620Medicaid
IA080047407OtherRR MEDICARE
IA1174509228Medicaid
IA5057620Medicaid
E47258Medicare UPIN