MEDICARE: BENJAMIN DEVRIES DO LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center
2	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	72062	OTHER		BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558916494
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENJAMIN DEVRIES DO LLC

Provider Business Mailing Address
First Line	:	1831 N BELCHER RD STE A3
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33765-1417
Country	:	US
Telephone Number	:	727-600-8500
Fax Number	:	877-692-1943

Provider Business Practice Location Address
First Line	:	1831 N BELCHER RD STE A3
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33765-1417
Country	:	US
Telephone Number	:	727-600-8500
Fax Number	:	877-692-1943

Authorized Official
Title or Position	:	OWNER
Name	:	BENJAMIN DEVRIES
Credential	:
Telephone Number	:	727-600-8500

Provider Enumeration Date	:	08/07/2019
Last Update Date	:	01/07/2026

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Directions to “BENJAMIN DEVRIES DO LLC ” Practice Location

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