Individual
DEREK B BENZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2725 S CRUTCHER AVE, SPRINGFIELD, MO 65804-3837
(000) 000-0000
Mailing address
2725 S CRUTCHER AVE, SPRINGFIELD, MO 65804-3837
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2021006539
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2021006539
STATE LICENSE
MO
Enumeration date
02/24/2021
Last updated
03/21/2025
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