Provider Demographics
NPI:1154821080
Name:BENITO, JORGE D (DO)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:D
Last Name:BENITO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:404 SHOPPERS DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-1301
Mailing Address - Country:US
Mailing Address - Phone:859-737-5333
Mailing Address - Fax:859-737-0070
Practice Address - Street 1:1138 LEXINGTON RD STE 110
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9673
Practice Address - Country:US
Practice Address - Phone:502-570-3754
Practice Address - Fax:502-570-3456
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34.016480207X00000X
KYTP119207X00000X
KY05846207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100971460Medicaid