Provider Demographics
NPI:1811959620
Name:BENEDETTI, PHILIP FRANK (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:FRANK
Last Name:BENEDETTI
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 1547
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-0361
Mailing Address - Country:US
Mailing Address - Phone:541-673-4303
Mailing Address - Fax:541-673-4303
Practice Address - Street 1:1813 W HARVARD AVE
Practice Address - Street 2:SUITE 432
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-2752
Practice Address - Country:US
Practice Address - Phone:541-673-4303
Practice Address - Fax:541-673-4303
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD192092085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR071832Medicaid
OHP00727911OtherRR MEDICARE
ORR145807Medicare PIN
OHP00727911OtherRR MEDICARE
OR00WCBCNQMedicare ID - Type Unspecified