Provider Demographics
NPI:1245393982
Name:JEOFFREY P BENSON MD INC
Entity Type:Organization
Organization Name:JEOFFREY P BENSON MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEOFFREY
Authorized Official - Middle Name:P
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-682-5520
Mailing Address - Street 1:PO BOX 30733
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93130-0733
Mailing Address - Country:US
Mailing Address - Phone:805-682-5520
Mailing Address - Fax:805-682-1632
Practice Address - Street 1:504 W PUEBLO ST
Practice Address - Street 2:SUITE 301
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-6211
Practice Address - Country:US
Practice Address - Phone:805-682-5520
Practice Address - Fax:805-682-1632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-17
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG58983207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE35862Medicare UPIN