Provider Demographics
NPI:1255332458
Name:BENZING, JEFFREY R (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:R
Last Name:BENZING
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 1:202A DRINKWATER RD
Mailing Address - Street 2:
Mailing Address - City:BAY ST LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:39520-1638
Mailing Address - Country:US
Mailing Address - Phone:228-467-2878
Mailing Address - Fax:228-467-2664
Practice Address - Street 1:202A DRINKWATER RD
Practice Address - Street 2:
Practice Address - City:BAY ST LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39520-1638
Practice Address - Country:US
Practice Address - Phone:228-467-2878
Practice Address - Fax:228-467-2664
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS80183213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSU66968Medicare UPIN