Individual
DR. BENSON ELLISON LANE TIMMONS IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
649 N NEW HOPE RD, GASTONIA, NC 28054-7424
(704) 866-4005
(704) 866-0450
Mailing address
1072 X RAY DR, GASTONIA, NC 28054-7488
(704) 671-1094
(704) 671-1095
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
39341
NC
2086S0122X
Plastic and Reconstructive Surgery Physician
39341
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2165882F
MEDICARE
—
01
—
2165882G
MEDICARE
—
01
—
8354X
BCBS
—
05
—
898354X
—
NC
Enumeration date
08/10/2005
Last updated
06/23/2020
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