Provider Demographics
NPI:1356493571
Name:GIAP, BENTON T (MD)
Entity Type:Individual
Prefix:
First Name:BENTON
Middle Name:T
Last Name:GIAP
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 1:101 CRESCENT WAY APT 2111
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94134-3362
Mailing Address - Country:US
Mailing Address - Phone:617-304-0691
Mailing Address - Fax:
Practice Address - Street 1:101 CRESCENT WAY APT 2111
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94134-3362
Practice Address - Country:US
Practice Address - Phone:617-304-0691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69428208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A694280Medicaid
00A694280Medicare ID - Type Unspecified
CA00A694280Medicaid