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General NPI Number Information
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NPI Number | 1518271345
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Entity Type | Organization
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Legal Business Name | OSWALDO D BENITEZ MD PA
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Dates
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Enumeration Date | 08/04/2010
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Last Update Date | 08/13/2010
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Provider Practice Location Address
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Address Line | 408 S 25TH ST
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City | FORT PIERCE
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State | FL
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Zip | 34947-3638
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Country | US
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Telephone | 772-465-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 408 S 25TH ST
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City | FORT PIERCE
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State | FL
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Zip | 34947-3638
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | OSWALDO D BENITEZ
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Credential | MD
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Telephone | 772-465-6800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME0011592
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License Number State | FL
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