Provider Demographics
NPI:1487655288
Name:BENSON, JEFFRE J (MD)
Entity type:Individual
Prefix:MR
First Name:JEFFRE
Middle Name:J
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 1:200 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905-0001
Mailing Address - Country:US
Mailing Address - Phone:715-838-5222
Mailing Address - Fax:715-834-3087
Practice Address - Street 1:1221 WHIPPLE ST
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-5270
Practice Address - Country:US
Practice Address - Phone:715-838-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24936207R00000X
WI66014-20207L00000X
ND12789207L00000X
WI66014207L00000X
MN104915207L00000X
MN53275207L00000X
IA24936207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ383266Medicaid
AZAW9360OtherHEALTHNET
IA1487655288Medicaid
AZAZ0779990OtherBCBS
AZ3946447OtherAETNA
MN050002399Medicare PIN
AZZ109568Medicare PIN
AZ383266Medicaid