Healthcare Provider Details

I. General information

NPI: 1548899222
Provider Name (Legal Business Name): BENJAMIN JAMES FARLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2020
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 MEMORIAL MEDICAL PKWY STE 2801
PALM COAST FL
32164-5999
US

IV. Provider business mailing address

4601 PARK RD STE 300
CHARLOTTE NC
28209-2290
US

V. Phone/Fax

Practice location:
  • Phone: 386-232-9210
  • Fax: 386-586-1939
Mailing address:
  • Phone: 704-696-2248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberME182154
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: