Provider Demographics
NPI:1972742963
Name:BENES, OLIVER JAMES (MD)
Entity Type:Individual
Prefix:
First Name:OLIVER
Middle Name:JAMES
Last Name:BENES
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 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-371-1153
Mailing Address - Fax:859-647-5113
Practice Address - Street 1:20 W 18TH ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-3329
Practice Address - Country:US
Practice Address - Phone:859-757-0717
Practice Address - Fax:859-331-2425
Is Sole Proprietor?:No
Enumeration Date:2009-02-13
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY42910207Q00000X, 2083A0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100153650Medicaid
KYP400039563Medicare PIN
KY7100153650Medicaid