Provider Demographics
NPI:1902845456
Name:BENSON, DAVID C (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:BENSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6001
Mailing Address - Country:US
Mailing Address - Phone:218-732-2800
Mailing Address - Fax:218-732-2874
Practice Address - Street 1:705 PLEASANT AVE S
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1440
Practice Address - Country:US
Practice Address - Phone:218-732-2800
Practice Address - Fax:218-732-2874
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN39544207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN47Q13BEOtherMNBS #
FMDA9041026961OtherPREFERRED ONE #
MN18686Medicaid
MN47Q11BEOtherMNBS #
MN900332OtherAMERICA'S PPO/ARAZ #
FM0106009OtherMEDICA #
MN0106010OtherMEDICA #
FM15624OtherNDBS #
MN47Q12BEOtherMNBS #
MNHP25649OtherHEALTHPARTNERS #
MNMN100042OtherLHS/BANNERHEALTH #
MN0106008OtherMEDICA #
MN150203OtherUCARE #
MN16740OtherSIOUX VALLEY #
FM0106009OtherMEDICA #
MN900332OtherAMERICA'S PPO/ARAZ #
MN080006650Medicare ID - Type UnspecifiedMN MEDICARE #
MN777723000Medicare ID - Type UnspecifiedMN MEDICAID #
MN18686Medicaid