=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972382976
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR BENJAMIN SOFFER PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2023
-----------------------------------------------------
Last Update Date | 12/17/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2901 CLINT MOORE RD # 5060
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33496-2041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-468-6981
-----------------------------------------------------
Fax | 561-709-4606
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2901 CLINT MOORE RD # 5060
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33496-2041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-468-6981
-----------------------------------------------------
Fax | 561-709-4606
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BENJAMIN SOFFER
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 561-468-6981
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------