Provider Demographics
NPI:1487638011
Name:BENSON, VERNON ROGER (MD)
Entity type:Individual
Prefix:DR
First Name:VERNON
Middle Name:ROGER
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 1:8109 FREDERICKSBURG RD
Mailing Address - Street 2:PHYSICIAN PRACTICE SERVICES
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3311
Mailing Address - Country:US
Mailing Address - Phone:210-404-0000
Mailing Address - Fax:210-404-2812
Practice Address - Street 1:1139 E SONTERRA BLVD
Practice Address - Street 2:SUITE 405
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4347
Practice Address - Country:US
Practice Address - Phone:210-404-0000
Practice Address - Fax:210-404-2812
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD7915207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1018616-03Medicaid
P01136136OtherRAILROAD MEDICARE
TX8DL459OtherBCBSTX
TX101861608Medicaid
TX1018616-03Medicaid
TX8639J4Medicare ID - Type Unspecified
TXB21202Medicare UPIN
P00673282OtherMEDICARE RR
TX1018616-05Medicaid
TXH08BP58101OtherBCBS