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General NPI Number Information
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NPI Number | 1619142957
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Entity Type | Individual
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Provider Name | BENJAMIN MARK SHORE D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/28/2008
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Last Update Date | 04/28/2008
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Provider Practice Location Address
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Address Line | 2532 REGATTA AVE SUNSET ISLAND 2
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City | MIAMI BEACH
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State | FL
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Zip | 33140-4235
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Country | US
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Telephone | 305-532-2532
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Fax | 305-532-9330
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Provider Business Mailing Address
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Address Line | 2532 REGATTA AVE SUNSET ISLAND 2
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City | MIAMI BEACH
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State | FL
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Zip | 33140-4235
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Country | US
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Telephone | 305-532-2532
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Fax | 305-532-9330
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | OS-0003915
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | OS-0003915
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License Number State | FL
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