Provider Demographics
NPI:1760653125
Name:JOHNSON, BENSTON DANIEL (DO)
Entity Type:Individual
Prefix:DR
First Name:BENSTON
Middle Name:DANIEL
Last Name:JOHNSON
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 1:6633 FOREST AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-2612
Mailing Address - Country:US
Mailing Address - Phone:727-845-4300
Mailing Address - Fax:813-635-7834
Practice Address - Street 1:6633 FOREST AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-2612
Practice Address - Country:US
Practice Address - Phone:727-845-4300
Practice Address - Fax:813-635-7834
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10941207R00000X, 207R00000X
NC200800539207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002891500Medicaid
FL002891500Medicaid
FLDE094WMedicare PIN