Provider Demographics
NPI:1639275340
Name:BENJAMIN, EUGENE (MD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:M
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:PO BOX 630
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950
Mailing Address - Country:US
Mailing Address - Phone:831-915-0567
Mailing Address - Fax:
Practice Address - Street 1:220 COUNTRY CLUB GATE CENTER
Practice Address - Street 2:SUITE 27
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950
Practice Address - Country:US
Practice Address - Phone:831-915-0567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56241207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G71585Medicare UPIN