Healthcare Provider Details

I. General information

NPI: 1265405179
Provider Name (Legal Business Name): PAUL L BENFANTI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 6TH AVE S STE 450
ST PETERSBURG FL
33701-4629
US

IV. Provider business mailing address

625 6TH AVE S STE 450
ST PETERSBURG FL
33701-4629
US

V. Phone/Fax

Practice location:
  • Phone: 727-898-2663
  • Fax: 727-568-6836
Mailing address:
  • Phone: 727-898-2663
  • Fax: 727-568-6836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME107895
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberME107895
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: