Individual
JONATHAN D BENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11104 PARKVIEW CIRCLE DR STE 310, FORT WAYNE, IN 46845-1733
(260) 266-5230
(260) 266-5238
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01060622A
IN
207RG0100X
Gastroenterology Physician
Primary
01060622A
IN
207RG0100X
Gastroenterology Physician
44963
TN
208000000X
Pediatrics Physician
01060622A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200529630
—
IN
01
—
4234546
BCBS
TN
Enumeration date
04/26/2006
Last updated
06/05/2023
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