Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | MD10154 | OR |
NPI | 1003959412 |
---|---|
Provider Name | James Benton |
First Address | Medford, OR 97501-6041 |
Second Address | Medford, OR 97504-9502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
287513 | (05) | OR |
FO4822 | (02) |