Provider Demographics
NPI:1437133121
Name:BENFIELD, JERRY MICHAEL JR (MD)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:MICHAEL
Last Name:BENFIELD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:801 BARRET AVE
Mailing Address - Street 2:STE 112
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-1732
Mailing Address - Country:US
Mailing Address - Phone:502-327-9100
Mailing Address - Fax:855-632-8329
Practice Address - Street 1:801 BARRET AVE
Practice Address - Street 2:STE 112
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204
Practice Address - Country:US
Practice Address - Phone:502-200-8259
Practice Address - Fax:502-584-8379
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01056286A207R00000X
FLME122430207R00000X
KY38836207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000365262OtherBCBS
KY64097728Medicaid
P00222068OtherRAILROAD MEDICARE
2448540000OtherPASSPORT ADVANTAGE
IN247380AMedicare PIN
2448540000OtherPASSPORT ADVANTAGE
KY0928401Medicare PIN