Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 4585 | SD |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 4585 | SD |
NPI | 1649259227 |
---|---|
Provider Name | Kevin D Benson |
First Address | Sioux Falls, SD 57117-5074 |
Second Address | Sioux Falls, SD 57105-7702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2006 |
Last Update Date | 12/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6201200 | (05) | SD |
H00670 | (02) |