Provider Demographics
NPI:1386636694
Name:BENEFIELD, DONALD W (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:W
Last Name:BENEFIELD
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 1:11240 HIGHWAY 49 STE 300
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-4151
Mailing Address - Country:US
Mailing Address - Phone:228-328-0972
Mailing Address - Fax:228-328-0975
Practice Address - Street 1:11240 HIGHWAY 49 STE 300
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-4151
Practice Address - Country:US
Practice Address - Phone:228-328-0972
Practice Address - Fax:228-328-0975
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12410174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0015674Medicaid
MS0015674Medicaid
MS180000076Medicare ID - Type Unspecified
MSB65688Medicare UPIN