Provider Demographics
NPI:1760781645
Name:BENSON, COOPER ROTH (MD)
Entity Type:Individual
Prefix:
First Name:COOPER
Middle Name:ROTH
Last Name:BENSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1430 TULANE AVE # 8422
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2632
Mailing Address - Country:US
Mailing Address - Phone:504-988-2300
Mailing Address - Fax:504-988-3969
Practice Address - Street 1:1415 TULANE AVE FL 3
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2600
Practice Address - Country:US
Practice Address - Phone:504-988-5271
Practice Address - Fax:504-988-7655
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA308825208800000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology