Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | ME23061 | FL |
NPI | 1730306200 |
---|---|
Provider Name | Dr. Andre William Benson |
First Address | Weeki Wachee, FL 34613-3418 |
Second Address | Port Richey, FL 34668-6553 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 29/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
376961501 | (05) | FL |
D61599 | (02) | FL |