DR. BENTON JOHN DAVIDSON (NPI# 1013944016) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013944016 |
| Entity Type | Individual |
| Full Name | DR. BENTON JOHN DAVIDSON |
| Credential | MD |
| Practice Address |
1174 Cornucopia St Nw Suite 240 Salem OR 97304-3193 |
| Practice Telephone | 5033851664 |
| Practice Fax Number | 5039915768 |
| Mailing Telephone | 5033851664 |
| Mailing Fax Number | 5039915768 |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2012-03-28 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
MD21643 | OR | Allopathic & Osteopathic Physicians |
| N | 2084N0600X |
Psychiatry & Neurology Specialization: Clinical Neurophysiology |
MD21643 | OR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 288103 | 05 |
| Street Address |
1174 CORNUCOPIA ST NW SUITE 240 |
| City | SALEM |
| State | OR |
| Zip Code | 97304-3193 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114527066 | Vanessa Trujillo Verduzco | Behavior Technician | 1174 Cornucopia St Nw, Salem, OR 97304-3193 | 2020-10-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114413010 | Sam Mackenzie Lane | Massage Therapist | 1661 Edgewater St Nw # 120, Salem, Or 97304, Salem, OR 97304 | 2018-07-03 |
| 1144761131 | Rachel E Carson | Physical Therapist | 1025 2nd St. Nw, West Salem, OR 97304 | 2017-03-10 |
| 1962951061 | Lee Ann Nail | Social Worker | 3965 Gibson Rd Nw, Salem, OR 97304 | 2016-09-29 |
| 1619421591 | Logan Walters | Physical Therapist | 1025 2nd St Nw, Salem, OR 97304 | 2016-08-09 |
| 1770941338 | Tysandra Gillis | Massage Therapist | 859 Mule Deer St., Salem, OR 97304 | 2016-02-10 |
| 1144620295 | Molly Rodden | Nurse Practitioner | 1174 Cornucopia St Nw Ste 240, Salem, OR 97304 | 2014-08-26 |
| 1881942126 | Cynthia Ruth Rettler | Registered Nurse | 1520 Plaza St Nw Ste 150, Salem, OR 97304 | 2012-08-16 |
| 1336401017 | Trillium Family Services | Community/Behavioral Health | 1520 Plaza Street Nw, Suite 100, Salem, OR 97304 | 2012-06-08 |
| 1033428198 | Kathleen Ketelson | Nurse Practitioner | 560 Wallace Rd Nw Ste 140, Salem, OR 97304 | 2010-10-06 |
| 1922332535 | Robert Scott Mcadam | Social Worker | 1245 Edgewater St. Nw, Salem, OR 97304 | 2009-09-29 |
| Find all providers in zip 97304 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104025634 | Thye Matthew Schuyler | Psychiatry & Neurology | Salem Health Sleep Center, 875 Oak St Se, Bldg C, Suite 3060, Salem, OR 97301-3975 | 2007-07-14 |
| 1124193727 | Donna Marie Capin | Psychiatry & Neurology | North Shore Children's Hospital, 57 Highland Ave, Salem, MA 01970 | 2006-11-21 |
| 1962447730 | Keifong William Seeto | Psychiatry & Neurology | 960 Liberty St Se, Suite 140, Salem, OR 97302-4165 | 2006-06-17 |
| 1750332516 | Michael L Wynn I | Psychiatry & Neurology | 1655 Liberty St Se, Salem, OR 97302-4347 | 2006-05-15 |
| 1033183249 | Valley Neurology Associates PC | Psychiatry & Neurology | 1904 Braeburn Dr, Salem, VA 24153 | 2006-02-14 |
| 1689648883 | Howard B Sherman | Psychiatry & Neurology | 1942 Braeburn Cir, Salem, VA 24153-7388 | 2006-02-14 |
| 1447247630 | James A Whitlock | Psychiatry & Neurology | 70 Butler St, Salem, NH 03079-3925 | 2005-10-03 |
| 1669470670 | Kenten D Woolhiser | Psychiatry & Neurology | 966 12th St Se, Salem, OR 97302-2859 | 2005-07-13 |
| 1770997009 | Urooba Faheem | Psychiatry & Neurology | 875 Oak St Se, Salem, OR 97301-3975 | 2014-06-14 |
| 1548515737 | Syed Omar Yousuf Kazmi | Psychiatry & Neurology | 890 Oak St Se, Salem, OR 97301-3905 | 2012-07-13 |
| Find all providers in SALEM | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.