| Doctor Name: | LANIE BENSON |
| NPI Number: | 1215344353 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | D9358 |
| Business Practice Address: | 460 N 3rd E Driggs, ID - 834225146 |
| Business Phone Number: | 2088212141 |
| Business Fax Number: | |
| Mailing Address: | Po Box 847, DRIGGS |
| State: | ID |
| Postal Code: | 834220847 |
| Phone Number: | 2088212141 |
| Fax Number: | |
| NPI Enumeration Date: | 07/22/2014 |
| NPI Last Update Date: | 07/22/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | D9358 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |