Provider Demographics
NPI:1205816287
Name:BENSON, JOHN W (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:BENSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1230 E MAIN ST
Mailing Address - Street 2:PO BOX 8674
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-5066
Mailing Address - Country:US
Mailing Address - Phone:507-625-1811
Mailing Address - Fax:
Practice Address - Street 1:1421 PREMIERE DR
Practice Address - Street 2:MANKATO CLINIC AT WICKERSHAM
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6076
Practice Address - Country:US
Practice Address - Phone:507-625-1811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN40637207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0102892OtherMEDICA
41084933956001C120OtherCHAMPUS
IA0511147Medicaid
MN101044OtherUCARE
MN29B64BEOtherBCBS
08028065OtherRR MEDICARE
MN895654OtherAMERICAS PPO
MNHP26511OtherHEALTH PARTNERS
MN829525500Medicaid
MNNA2951023816OtherPREFERRED ONE
MN895654OtherAMERICAS PPO
MN0102892OtherMEDICA