Individual
DR. SCOTT WALD BENNINGHOVEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8833 MONTEREY RD STE F, GILROY, CA 95020-7200
(408) 848-3799
(408) 848-5490
Mailing address
8833 MONTEREY RD STE F, GILROY, CA 95020-7200
(408) 848-3799
(408) 848-5490
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
G55118
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G551180
—
CA
Enumeration date
04/03/2007
Last updated
09/27/2012
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