Provider Demographics
NPI:1558621821
Name:BENSON, BRIAN K (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:K
Last Name:BENSON
Suffix:
Gender:M
Credentials:MD PHD
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Mailing Address - Street 1:6720 GREENMEADOW DR
Mailing Address - Street 2:
Mailing Address - City:GREENWELL SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70739-4102
Mailing Address - Country:US
Mailing Address - Phone:225-978-4264
Mailing Address - Fax:225-381-2579
Practice Address - Street 1:12011 BRICKSOME AVE STE B
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2994
Practice Address - Country:US
Practice Address - Phone:225-713-4050
Practice Address - Fax:225-713-4050
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.206602207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2196081Medicaid