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General NPI Number Information
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NPI Number | 1073506291
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Entity Type | Individual
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Provider Name | BENJAMIN R PROTO DPM
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Gender | Male
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Dates
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Enumeration Date | 08/23/2005
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Last Update Date | 12/14/2016
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Provider Practice Location Address
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Address Line | 860 OMNI BLVD SUITE 113
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City | NEWPORT NEWS
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State | VA
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Zip | 23606
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Country | US
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Telephone | 757-327-0657
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Fax | 757-327-0658
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Provider Business Mailing Address
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Address Line | 860 OMNI BLVD SUITE 303
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City | NEWPORT NEWS
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State | VA
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Zip | 23606
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Country | US
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Telephone | 757-232-8777
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Fax | 757-232-8866
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 0103300835
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 0103300835
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License Number State | VA
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