Basic Information
| Provider Information | |||||||||
| NPI: | 1669429320 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENOIT | ||||||||
| FirstName: | MARTIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13640 N PLAZA DEL RIO BLVD | ||||||||
| Address2: | |||||||||
| City: | PEORIA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853814846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6238763800 | ||||||||
| FaxNumber: | 6239729590 | ||||||||
| Practice Location | |||||||||
| Address1: | 9165 W THUNDERBIRD RD | ||||||||
| Address2: | STE 200 | ||||||||
| City: | PEORIA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853814847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6238763870 | ||||||||
| FaxNumber: | 6238150087 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2006 | ||||||||
| LastUpdateDate: | 12/02/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 42145 | MN | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 834327600 | 05 | MN | MEDICAID | 0900337 | 01 | MN | MEDICA # | OTHER | 74D75BE | 01 | FM | MNBS # | OTHER | 88D59BE | 01 | FM | MNBS # | OTHER | DA9031026960 | 01 | FM | PREFERRED ONE # | OTHER | 19426 | 01 | MN | NDBS # | OTHER | MN200035 | 01 | MN | LHS/BANNERHEALTH # | OTHER | 19264 | 01 | MN | NDBS # | OTHER | HP38104 | 01 | MN | HEALTHPARTNERS # | OTHER | 11171 | 05 | MN | MEDICAID | 900331 | 01 | MN | AMERICA'S PPO/ARAZ # | OTHER | DA9041026960 | 01 | MN | PREFERRED ONE # | OTHER | 0900338 | 01 | MN | MEDICA # | OTHER | 127580 | 05 | AZ | MEDICAID | 167358 | 01 | FM | UCARE # | OTHER |