Healthcare Provider Details

I. General information

NPI: 1699727743
Provider Name (Legal Business Name): PEGGY BENZING D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8431 POINTE LOOP DR FIRST FLOOR
VENICE FL
34293-2232
US

IV. Provider business mailing address

1605 MANOR RD
ENGLEWOOD FL
34223-4929
US

V. Phone/Fax

Practice location:
  • Phone: 941-207-5320
  • Fax: 941-207-5321
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS5456
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS55456
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: