Healthcare Provider Details

I. General information

NPI: 1194119214
Provider Name (Legal Business Name): BENJAMIN JAMES DIONNE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 SHIRCLIFF WAY STE 400
JACKSONVILLE FL
32204
US

IV. Provider business mailing address

4205 BELFORT RD STE 4015
JACKSONVILLE FL
32216-3623
US

V. Phone/Fax

Practice location:
  • Phone: 904-308-4000
  • Fax: 904-308-8938
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberME135716
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: