Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | OS15463 | FL |
N | 207QA0505X | Family Doctor - Adult Medicine | 5253 | FL |
NPI | 1003331919 |
---|---|
Provider Name | Benjamin Klein |
First Address | Ft Lauderdale, FL 33309-3750 |
Second Address | Plantation, FL 33322-5207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2017 |
Last Update Date | 26/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103964000 | (05) | FL |