Individual
PETER BENSON C SO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11104 PARKVIEW CIRCLE DR STE 440, FORT WAYNE, IN 46845-1672
(260) 373-9935
(260) 373-9926
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
01057994A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000604550
ANTHEM
IN
05
—
200455540
—
IN
01
—
P00732005
RAILROAD MEDICARE
IN
Enumeration date
07/31/2006
Last updated
10/17/2022
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