Healthcare Provider Details

I. General information

NPI: 1619173309
Provider Name (Legal Business Name): BENOIT C PINEAU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 05/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WHETSTONE PLACE SUITE 105
ST. AUGUSTINE FL
32086
US

IV. Provider business mailing address

4800 BELFORT ROAD
JACKSONVILLE FL
32256
US

V. Phone/Fax

Practice location:
  • Phone: 904-829-9557
  • Fax: 904-829-9125
Mailing address:
  • Phone: 904-398-3262
  • Fax: 904-265-4807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME90376
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: