Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 1983 | AL |
Y | 213ES0000X | Sports Medicine | 1983 | AL |
NPI | 1457876278 |
---|---|
Provider Name | Mr. Samuel Benson |
First Address | Florence, AL 35632-0001 |
Second Address | Florence, AL 35632-0002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2017 |
Last Update Date | 14/08/2017 |