Individual
DR. BENTON JOHN DAVIDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1174 CORNUCOPIA ST NW, SUITE 240, SALEM, OR 97304-3193
(503) 385-1664
(503) 991-5768
Mailing address
1174 CORNUCOPIA ST NW, SUITE 240, SALEM, OR 97304-3193
(503) 385-1664
(503) 991-5768
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
MD21643
OR
2084N0600X
Clinical Neurophysiology Physician
MD21643
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
288103
—
OR
Enumeration date
06/26/2006
Last updated
03/28/2012
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