Provider Demographics
NPI:1306985080
Name:BENSON, DALE STANELY (MD)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:STANELY
Last Name:BENSON
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 1:350 N MERIDIAN ST
Mailing Address - Street 2:UNIT 303
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-1757
Mailing Address - Country:US
Mailing Address - Phone:317-638-0075
Mailing Address - Fax:
Practice Address - Street 1:350 N MERIDIAN ST
Practice Address - Street 2:UNIT 303
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-1757
Practice Address - Country:US
Practice Address - Phone:317-638-0075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01021433A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine