Provider Demographics
NPI:1205331899
Name:JOHNSON, BENJAMIN ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:ROBERT
Last Name:JOHNSON
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 1:5900 SIX FORKS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-8226
Mailing Address - Country:US
Mailing Address - Phone:919-876-4327
Mailing Address - Fax:919-876-6800
Practice Address - Street 1:5900 SIX FORKS RD STE 200
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-8226
Practice Address - Country:US
Practice Address - Phone:919-876-4327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2025-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC202500997207YX0901X, 207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology