Provider Demographics
NPI:1629028584
Name:BENSON, STUART (DO)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:
Last Name:BENSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 NW LOWES AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-8093
Mailing Address - Country:US
Mailing Address - Phone:479-254-8563
Mailing Address - Fax:479-254-8564
Practice Address - Street 1:808 S 52ND ST STE 201
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8602
Practice Address - Country:US
Practice Address - Phone:479-319-6009
Practice Address - Fax:479-319-6140
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN8033207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR54185OtherBLUE
AR118662003Medicaid
E91741Medicare UPIN
AR54185Medicare ID - Type Unspecified