Provider Demographics
NPI:1811004245
Name:BENFIELD, MARK R (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:BENFIELD
Suffix:
Gender:M
Credentials:MD
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1425 RICHARD ARRINGTON JR BLVD S
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-3898
Mailing Address - Country:US
Mailing Address - Phone:205-558-3200
Mailing Address - Fax:205-558-2055
Practice Address - Street 1:1425 RICHARD ARRINGTON JR BLVD S
Practice Address - Street 2:SUITE 206
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-3898
Practice Address - Country:US
Practice Address - Phone:205-558-3200
Practice Address - Fax:205-558-2055
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2010-08-18
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Provider Licenses
StateLicense IDTaxonomies
AL122842080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000028811Medicaid
MS0120252Medicaid
AL000015888Medicaid
51028811Medicare ID - Type Unspecified
51015888Medicare ID - Type Unspecified
AL000015888Medicaid