Healthcare Provider Details

I. General information

NPI: 1558916494
Provider Name (Legal Business Name): BENJAMIN DEVRIES DO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2019
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1831 N BELCHER RD STE A3
CLEARWATER FL
33765-1417
US

IV. Provider business mailing address

1831 N BELCHER RD STE A3
CLEARWATER FL
33765-1417
US

V. Phone/Fax

Practice location:
  • Phone: 727-600-8500
  • Fax: 877-692-1943
Mailing address:
  • Phone: 727-600-8500
  • Fax: 877-692-1943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN DEVRIES
Title or Position: OWNER
Credential:
Phone: 727-600-8500