Provider Demographics
NPI:1720092547
Name:BENSON, CHRIS H (MD)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:H
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 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-268-5170
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:104 MILLSAPS DR
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1328
Practice Address - Country:US
Practice Address - Phone:601-268-5170
Practice Address - Fax:601-268-5179
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08866207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1419958Medicaid
MS1558919OtherAMERICAN ADMIN GROUP
110014737OtherRAILROAD MEDICARE
MS00014987Medicaid
110014737OtherRAILROAD MEDICARE
MS1558919OtherAMERICAN ADMIN GROUP