Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 40592 | AZ |
NPI | 1114183977 |
---|---|
Provider Name | Dr. Ivor Benjamin |
First Address | Los Angeles, CA 90074-6765 |
Second Address | Phoenix, AZ 85013-4224 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2008 |
Last Update Date | 23/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
399522 | (05) | AZ |