Individual
MARK PALMER BENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
707 NORTH 7TH, POCATELLO, ID 83201
(208) 233-4562
(208) 234-4638
Mailing address
707 NORTH 7TH, POCATELLO, ID 83201
(208) 233-4562
(208) 234-4638
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M3650
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000100001648
BLUE SHIELD
ID
05
—
002440600
—
ID
05
—
003608500
—
ID
01
—
110042845
RR MEDICARE
ID
01
—
29296
BLUE SHIELD GROUP NUMBER
ID
01
—
36509
BLUE CROSS
ID
01
—
88765
BLUE CROSS GROUP NUMBER
ID
01
—
CP9190
RAILROAD MEDICARE GRP #
ID
Enumeration date
11/29/2006
Last updated
11/10/2011
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