MEDICARE: DR. JOHNNY C. BENJAMIN JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XS0117X	Orthopaedic Surgery of the Spine Physician	ME 0070165	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	200040285	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	28917	OTHER	FL	BLUE CROSS BLUE SHIELD FL
4	4295190001	OTHER	FL	PALMETTO
5	593604327	OTHER	FL	CHAMPUS

General Provider Information

NPI Number	:	1265464168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHNNY C. BENJAMIN JR. M.D.

Provider Business Mailing Address
First Line	:	1355 37TH ST
Second Line	:	SUITE 301
City	:	VERO BEACH
State	:	FL
Zip	:	32960-7320
Country	:	US
Telephone Number	:	772-978-7808
Fax Number	:	772-978-9320

Provider Business Practice Location Address
First Line	:	1355 37TH ST
Second Line	:	SUITE 301
City	:	VERO BEACH
State	:	FL
Zip	:	32960-7320
Country	:	US
Telephone Number	:	772-978-7808
Fax Number	:	772-978-9320

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	06/11/2013

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Directions to “ DR. JOHNNY C. BENJAMIN JR. M.D.” Practice Location

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