Provider Demographics
NPI:1669429320
Name:BENOIT, MARTIN (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:BENOIT
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 1:13640 N PLAZA DEL RIO BLVD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4846
Mailing Address - Country:US
Mailing Address - Phone:623-876-3800
Mailing Address - Fax:623-972-9590
Practice Address - Street 1:9165 W THUNDERBIRD RD
Practice Address - Street 2:STE 200
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4847
Practice Address - Country:US
Practice Address - Phone:623-876-3870
Practice Address - Fax:623-815-0087
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN42145207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN834327600Medicaid
MN0900337OtherMEDICA #
FM74D75BEOtherMNBS #
FM88D59BEOtherMNBS #
FMDA9031026960OtherPREFERRED ONE #
MN19426OtherNDBS #
MNMN200035OtherLHS/BANNERHEALTH #
MN19264OtherNDBS #
MNHP38104OtherHEALTHPARTNERS #
MN11171Medicaid
MN900331OtherAMERICA'S PPO/ARAZ #
MNDA9041026960OtherPREFERRED ONE #
MN0900338OtherMEDICA #
AZ127580Medicaid
FM167358OtherUCARE #
AZZ124214Medicare PIN
FM88D59BEOtherMNBS #
FM74D75BEOtherMNBS #
MN19264OtherNDBS #
MN200001639Medicare ID - Type UnspecifiedMN MEDICARE #
MNMN200035OtherLHS/BANNERHEALTH #