Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | ME 0070165 | FL |
NPI | 1265464168 |
---|---|
Provider Name | Dr. Johnny C. Benjamin JR. |
First Address | Vero Beach, FL 32960-7320 |
Second Address | Vero Beach, FL 32960-7320 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 11/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200040285 | RAILROAD MEDICARE (01) | FL |
250692100 | (05) | FL |
28917 | BLUE CROSS BLUE SHIELD FL (01) | FL |
4295190001 | PALMETTO (01) | FL |
593604327 | CHAMPUS (01) | FL |
G26676 | (02) | FL |