Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081S0010X | Sports Medicine | E4426 | CA |
N | 213ES0000X | Sports Medicine | E4426 | CA |
Y | 213ES0103X | Foot & Ankle Surgery | E4426 | CA |
NPI | 1508885278 |
---|---|
Provider Name | Dr. Stephen Andrew Benson |
First Address | Thousand Oaks, CA 91360-4236 |
Second Address | Thousand Oaks, CA 91360-4236 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 30/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E44260 | (05) | CA |
U95660 | (02) | CA |
W22604 | GROUP MEDICARE PIN (01) | CA |
W22604A | GROUP MEDICARE PIN (01) | CA |