Provider Demographics
NPI:1538110366
Name:BENSON, MORRIS SCOTT (PAC)
Entity Type:Individual
Prefix:
First Name:MORRIS
Middle Name:SCOTT
Last Name:BENSON
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 NORTH 20TH STREET # 18
Mailing Address - Street 2:P.O. BOX 2125
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36803-2125
Mailing Address - Country:US
Mailing Address - Phone:334-749-8303
Mailing Address - Fax:334-745-5243
Practice Address - Street 1:121 NORTH 20TH STREET # 18
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-5457
Practice Address - Country:US
Practice Address - Phone:334-749-8303
Practice Address - Fax:334-745-5243
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA 210363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51097401BENOtherBLUE CROSS & BLUE SHIELD
AL51097402BENOtherBLUE CROSS & BLUE SHIELD
AL51051184BENOtherBLUE CROSS & BLUE SHIELD
AL51097401BENOtherBLUE CROSS & BLUE SHIELD
ALS89455Medicare UPIN
AL000051185BENMedicare ID - Type Unspecified