Provider Demographics
NPI:1386925592
Name:DBENZMDPLLC
Entity type:Organization
Organization Name:DBENZMDPLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BENZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-256-1190
Mailing Address - Street 1:19110 NE 21ST ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-0907
Mailing Address - Country:US
Mailing Address - Phone:360-256-1190
Mailing Address - Fax:
Practice Address - Street 1:19110 NE 21ST ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-0907
Practice Address - Country:US
Practice Address - Phone:360-256-1190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00016331207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty