Provider Demographics
NPI:1316928674
Name:BENZ, ALFRED BROOKE (MD)
Entity type:Individual
Prefix:
First Name:ALFRED
Middle Name:BROOKE
Last Name:BENZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:A BROOKE
Other - Middle Name:
Other - Last Name:BENZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3397
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3397
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:727 S WAHANNA RD
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:OR
Practice Address - Zip Code:97138-7735
Practice Address - Country:US
Practice Address - Phone:503-717-7060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-11
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD14378207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR142059Medicaid
OR16082-0001OtherPACIFICARE
OR3048989-01OtherBCBS HMO
OR930924283OtherMHN
OR930924283OtherALL OTHER INSURANCE
ORP00162992OtherMEDICARE RAILROAD
OR142059Medicaid
OR3841070001OtherMCA DMERC
1154526341OtherMEDICARE GROUP NPI
OR048989000OtherBCBS OREGON
OR3048989-01OtherFIRST CHOICE 65
ORP00162992OtherMEDICARE RAILROAD