Provider Demographics
NPI:1760506745
Name:BENSON, MARK (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:BENSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:78120 WILDCAT DR
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-1140
Mailing Address - Country:US
Mailing Address - Phone:760-340-2682
Mailing Address - Fax:760-773-9695
Practice Address - Street 1:78120 WILDCAT DR
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-1140
Practice Address - Country:US
Practice Address - Phone:760-340-2682
Practice Address - Fax:760-773-9695
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4564207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1174577613OtherNPI
CAGR0069290Medicaid
CA00AX45640Medicaid
CA1174577613OtherNPI
CA00AX45640Medicaid
CAGR0069290Medicaid