Healthcare Provider Details

I. General information

NPI: 1750461620
Provider Name (Legal Business Name): BENJAMIN SOUTHER CITRIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 AIRPORT BLVD C138
MOBILE AL
36608-6705
US

IV. Provider business mailing address

6701 AIRPORT BLVD C138
MOBILE AL
36608-6705
US

V. Phone/Fax

Practice location:
  • Phone: 251-333-3333
  • Fax: 251-410-4444
Mailing address:
  • Phone: 251-333-3333
  • Fax: 251-410-4444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number18816
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number18816
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: