Provider Demographics
NPI:1952319865
Name:BENTON, DAVID E II (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:E
Last Name:BENTON
Suffix:II
Gender:M
Credentials:MD
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Mailing Address - Street 1:2550 E GUADALUPE
Mailing Address - Street 2:#107
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234
Mailing Address - Country:US
Mailing Address - Phone:480-964-5800
Mailing Address - Fax:480-632-5923
Practice Address - Street 1:2550 E GUADALUPE
Practice Address - Street 2:#107
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234
Practice Address - Country:US
Practice Address - Phone:480-964-5800
Practice Address - Fax:480-632-5923
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2010-06-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZAZ10054207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D86735Medicare UPIN
11WCJBL03Medicare ID - Type Unspecified