Provider Demographics
NPI:1467870774
Name:BENSON, TODD EVAN JR (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:EVAN
Last Name:BENSON
Suffix:JR
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 1:1005 W RALPH HALL PKWY STE 135
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-6691
Mailing Address - Country:US
Mailing Address - Phone:972-772-3100
Mailing Address - Fax:
Practice Address - Street 1:1005 W RALPH HALL PKWY STE 135
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6691
Practice Address - Country:US
Practice Address - Phone:972-772-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR2055208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics