Benton John Davidson, MD

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

MD21643 Issued in OR

Practice address

1174 Cornucopia St NW
Suite 240
Salem, OR 97304-3193

Phone

(503) 385-1664

Fax

(503) 991-5768

NPI assigned

Jun 26, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332892800000",
    "number": "1013944016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1174 CORNUCOPIA ST NW",
            "address_2": "SUITE 240",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973043193",
            "telephone_number": "503-385-1664",
            "fax_number": "503-991-5768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1174 CORNUCOPIA ST NW",
            "address_2": "SUITE 240",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973043193",
            "telephone_number": "503-385-1664",
            "fax_number": "503-991-5768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIDSON",
        "first_name": "BENTON",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-26",
        "last_updated": "2012-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "OR",
            "license": "MD21643",
            "primary": true
        },
        {
            "code": "2084N0600X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": "OR",
            "license": "MD21643",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "288103",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katherine Mariah Davenport, PSY.D.
• David M Freed PHD PC
• David M. Ross, DMD
• David Willis DMD, LLC
• Christopher Allen David
• Carli Davidson
• Diane Davidson, L.M.T.
• Jocelyn Linao Davidson, LMT
• Katherine Ellen S. Davidson, RNP/CNM
• Michele R Davidson, RDH

• Neurology Physician in Salem, OR
• Providers in Salem, OR by specialty
• Neurology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.