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General NPI Number Information
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NPI Number | 1073833497
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Entity Type | Individual
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Provider Name | BENJAMIN C SERVICE M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/08/2010
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Last Update Date | 03/19/2020
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Provider Practice Location Address
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Address Line | 1222 S ORANGE AVE
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City | ORLANDO
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State | FL
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Zip | 32806-1215
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Country | US
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Telephone | 407-423-7777
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Fax | 407-423-1380
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Provider Business Mailing Address
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Address Line | 7243 DELLA DR STE B
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City | ORLANDO
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State | FL
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Zip | 32819-5106
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Country | US
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Telephone | 321-842-0060
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Fax | 321-842-0084
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MD60545556
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | ME 124973
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License Number State | FL
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