Provider Demographics
NPI:1962700021
Name:BENZER, DAVID G (DO)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:G
Last Name:BENZER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16754 W EAGLE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FIFTY LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56448-2112
Mailing Address - Country:US
Mailing Address - Phone:218-763-4798
Mailing Address - Fax:
Practice Address - Street 1:16754 W EAGLE LAKE RD
Practice Address - Street 2:
Practice Address - City:FIFTY LAKES
Practice Address - State:MN
Practice Address - Zip Code:56448-2112
Practice Address - Country:US
Practice Address - Phone:218-763-4798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21573207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine