Individual
MR. JERRY MICHAEL BENFIELD JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
801 BARRET AVE, STE 112, LOUISVILLE, KY 40204
(502) 200-8259
(502) 584-8379
Mailing address
801 BARRET AVE, STE 112, LOUISVILLE, KY 40204-1732
(502) 327-9100
(855) 632-8329
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01056286A
IN
207R00000X
Internal Medicine Physician
Primary
38836
KY
207R00000X
Internal Medicine Physician
ME122430
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000365262
BCBS
—
01
—
2448540000
PASSPORT ADVANTAGE
—
05
—
64097728
—
KY
01
—
P00222068
RAILROAD MEDICARE
—
Enumeration date
12/06/2005
Last updated
07/11/2023
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