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General NPI Number Information
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NPI Number | 1790737922
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Entity Type | Organization
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Legal Business Name | DOCTORS AT HOME LLC
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 07/25/2012
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Provider Practice Location Address
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Address Line | 11479 CORTEZ BLVD
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City | BROOKSVILLE
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State | FL
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Zip | 34613-7367
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Country | US
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Telephone | 352-592-7777
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Fax | 352-592-1155
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Provider Business Mailing Address
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Address Line | 15215 CORTEZ BLVD
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City | BROOKSVILLE
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State | FL
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Zip | 34613-6072
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Country | US
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Telephone | 352-799-0046
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Fax | 352-799-0115
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Authorized Official
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Title or Position | OWNER
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Name | DR. DALTON M BENSON
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Credential | M.D.
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Telephone | 352-597-3511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 2005-00475004
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License Number State | FL
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