Individual
GREGORY THOMAS BENTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
95 E FAIRWAY DR, LAKEVIEW MEDICAL CENTER, COVINGTON, LA 70433-7500
(985) 867-4000
Mailing address
871 COLE CT, COVINGTON, LA 70433-7904
(504) 432-6458
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
199991
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063941
—
LA
Enumeration date
07/07/2006
Last updated
07/08/2007
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