Provider Demographics
NPI:1629369772
Name:BENSON, DANIEL GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:GREGORY
Last Name:BENSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3600 GASTON AVE
Mailing Address - Street 2:STE 1205
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1800
Mailing Address - Country:US
Mailing Address - Phone:214-692-8262
Mailing Address - Fax:214-696-4190
Practice Address - Street 1:3417 GASTON AVE
Practice Address - Street 2:SUITE 830
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246
Practice Address - Country:US
Practice Address - Phone:214-826-6021
Practice Address - Fax:214-823-9745
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2018-06-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXQ8833208800000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX367650403Medicaid