Individual
BENTON REAL STOUT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
1850 SPRING GARDEN ST, RIVERSIDE, CA 92507-2050
(951) 544-9589
Mailing address
1850 SPRING GARDEN ST, RIVERSIDE, CA 92507-2050
(951) 544-9589
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA20699
CA
Other
Enumeration date
11/18/2009
Last updated
11/18/2009
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