Individual
MARY BETH BENTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
402 KEENE ST, COLUMBIA, MO 65201-6626
(573) 499-6084
(573) 499-6088
Mailing address
PO BOX 7687, COLUMBIA, MO 65205-7687
(573) 882-2259
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
MDR2H46
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
126944
HEALTHLINK
MO
05
—
202817706
—
MO
01
—
2086348001
KANSAS MEDICAID
MO
01
—
6642
BLUE SHIELD
MO
01
—
704051
UNITED HEALTHCARE
MO
Enumeration date
06/01/2006
Last updated
12/21/2007
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