Provider Demographics
NPI:1871526186
Name:BENEDICK, DANIEL MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MICHAEL
Last Name:BENEDICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E. 33RD STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663
Mailing Address - Country:US
Mailing Address - Phone:360-514-7550
Mailing Address - Fax:208-367-6123
Practice Address - Street 1:100 E. 33RD STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663
Practice Address - Country:US
Practice Address - Phone:208-367-6030
Practice Address - Fax:208-367-6123
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMR-0864207Q00000X
WAMD60255737207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807490400Medicaid
ID1196034Medicare PIN
ID807490400Medicaid