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General NPI Number Information
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NPI Number | 1972726222
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Entity Type | Individual
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Provider Name | BENJAMIN JOHN LUDWIG MD
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Gender | Male
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 2428 SANTA MONICA BLVD
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City | SANTA MONICA
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State | CA
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Zip | 90404-2045
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Country | US
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Telephone | 310-315-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 172 SAN JUAN DR
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City | PONTE VEDRA BEACH
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State | FL
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Zip | 32082-1323
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Country | US
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Telephone | 954-303-2081
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Fax |
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | C184440
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME112384
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License Number State | FL
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