Healthcare Provider Details

I. General information

NPI: 1497018345
Provider Name (Legal Business Name): BENJAMIN DAVID OSTERRIEDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 12/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3754 HIGHWAY 90 STE 220
PACE FL
32571-1096
US

IV. Provider business mailing address

PO BOX 2699 ATTN: SHMG/HPE
PENSACOLA FL
32513-2699
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-5050
  • Fax: 850-416-5022
Mailing address:
  • Phone: 850-416-5050
  • Fax: 850-416-5022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME124744
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: