Provider Demographics
NPI:1528228046
Name:BENIGNO, DAISY MAY GAMOTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAISY
Middle Name:MAY GAMOTIN
Last Name:BENIGNO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:HICKMAN
Mailing Address - State:KY
Mailing Address - Zip Code:42050-1841
Mailing Address - Country:US
Mailing Address - Phone:270-236-3202
Mailing Address - Fax:270-236-9597
Practice Address - Street 1:2003 S 7TH ST
Practice Address - Street 2:
Practice Address - City:HICKMAN
Practice Address - State:KY
Practice Address - Zip Code:42050-1841
Practice Address - Country:US
Practice Address - Phone:270-236-3202
Practice Address - Fax:270-236-9597
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD .203568207Q00000X
LAMD.203568390200000X, 207QG0300X
KY43411207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine