Provider Demographics
NPI:1871912139
Name:CASON, BENTON
Entity type:Individual
Prefix:
First Name:BENTON
Middle Name:
Last Name:CASON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40010
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0010
Mailing Address - Country:US
Mailing Address - Phone:251-471-7117
Mailing Address - Fax:251-471-7096
Practice Address - Street 1:2055 E SOUTH BLVD STE 601
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-2014
Practice Address - Country:US
Practice Address - Phone:334-272-1050
Practice Address - Fax:334-271-7698
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL34842208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery