Basic Information
| Provider Information | |||||||||
| NPI: | 1710907753 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENTON | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | CASON | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 703 VOLKER HALL | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352940001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059343795 | ||||||||
| FaxNumber: | 2059752499 | ||||||||
| Practice Location | |||||||||
| Address1: | 1616 6TH AVE S | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352331788 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059399585 | ||||||||
| FaxNumber: | 2059756503 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 22100 | AL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 009968880 | 05 | AL | MEDICAID | 515-04727 | 01 | AL | BC BS | OTHER | 000044905 | 05 | AL | MEDICAID | 009999715 | 05 | AL | MEDICAID | G52662 | 01 | VIVA | OTHER |