Provider Demographics
NPI:1659475143
Name:BENJAMIN, MIGNON F (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGNON
Middle Name:F
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:641 WEST WILLOUGHBY AVE
Mailing Address - Street 2:ST 201
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801
Mailing Address - Country:US
Mailing Address - Phone:907-586-8100
Mailing Address - Fax:907-586-8102
Practice Address - Street 1:641 WEST WILLOUGHBY AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7809
Practice Address - Country:US
Practice Address - Phone:907-586-8100
Practice Address - Fax:907-586-8102
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9300421207Q00000X
AK6882207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8915026Medicaid
NC8915026Medicaid
NCG08836Medicare UPIN