Healthcare Provider Details

I. General information

NPI: 1528753399
Provider Name (Legal Business Name): BENSON JOSEPH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

944 21ST AVE N APT 412
NASHVILLE TN
37208-3449
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0646
  • Fax:
Mailing address:
  • Phone: 561-685-3412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: