Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 12284 | AL |
NPI | 1811004245 |
---|---|
Provider Name | Mark R Benfield |
First Address | Birmingham, AL 35205-3898 |
Second Address | Birmingham, AL 35205-3898 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 18/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000015888 | (05) | AL |
000028811 | (05) | AL |
0120252 | (05) | MS |
C79085 | (02) |