Provider Demographics
NPI:1376703454
Name:BENSCOTER, BRENT JASON (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:JASON
Last Name:BENSCOTER
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 1:1111 EXPOSITION BLVD BLDG 700
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4314
Mailing Address - Country:US
Mailing Address - Phone:916-736-3399
Mailing Address - Fax:916-736-3350
Practice Address - Street 1:1111 EXPOSITION BLVD BLDG 700
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4314
Practice Address - Country:US
Practice Address - Phone:916-736-3399
Practice Address - Fax:916-233-4171
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125053418207Y00000X
MI4301099963207YX0901X
IN01073373A207YX0901X
CAA150679207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201230760Medicaid
INFB4331803OtherDEA
IN199540002Medicare PIN