Individual
MR. DOUGLAS NEAL BENECKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
101 E WOOD ST, SPARTANBURG, SC 29303-3040
(864) 560-6000
Mailing address
3990 E BROAD ST, BLDG 11 SECTION 11, COLUMBUS, OH 43213-1152
(614) 336-7300
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2141
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1936PA
—
SC
01
—
SC37788510
MEDICARE PIN
SC
01
—
SC37789068
MEDICARE PIN
SC
Enumeration date
03/17/2010
Last updated
11/24/2020
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