Individual
JACK NILS BENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
19841 N 27TH AVE, SUITE 201, PHOENIX, AZ 85027-4005
(623) 582-6420
(623) 582-6720
Mailing address
19841 N 27TH AVE, SUITE 201, PHOENIX, AZ 85027-4005
(623) 582-6420
(623) 582-6720
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
1521
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1Z0539
HEALTHNET
AZ
05
—
246729
—
AZ
01
—
4316747
AETNA
AZ
01
—
AZ0066690
BLUECROSSBLUESHIELDAZ
AZ
Enumeration date
08/05/2006
Last updated
01/04/2008
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