Healthcare Provider Details

I. General information

NPI: 1023350113
Provider Name (Legal Business Name): BENSEN BENJAMIN FAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2013
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 S ORANGE AVE FL 5
ORLANDO FL
32806-1215
US

IV. Provider business mailing address

1222 S ORANGE AVE FL 5
ORLANDO FL
32806-1215
US

V. Phone/Fax

Practice location:
  • Phone: 844-362-1735
  • Fax: 321-841-3040
Mailing address:
  • Phone: 844-362-1735
  • Fax: 321-841-3040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME152894
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberME152894
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA154107
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25MA10638900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: