Provider Demographics
NPI:1962442954
Name:BENSON, ROBERT ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALAN
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 1:7800 NW 85TH TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-3385
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:731 12TH AVE NW STE 103
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-5762
Practice Address - Country:US
Practice Address - Phone:580-220-6180
Practice Address - Fax:580-226-1120
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44588174400000X
OK116243207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200018790AMedicaid
TX193634602Medicaid
TX193634602Medicaid
TX8K6490Medicare PIN
TX193634601Medicaid
TX8K6491Medicare PIN
TX193634602Medicaid
TX8K6490Medicare PIN
OKE48247Medicare UPIN