MEDICARE: DR. BENJAMIN MARK SHORE D.O.

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	207P00000X	Emergency Medicine Physician	OS-0003915	FL
2	208000000X	Pediatrics Physician	OS-0003915	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619142957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN MARK SHORE D.O.

Provider Business Mailing Address
First Line	:	2532 REGATTA AVE
Second Line	:	SUNSET ISLAND 2
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-4235
Country	:	US
Telephone Number	:	305-532-2532
Fax Number	:	305-532-9330

Provider Business Practice Location Address
First Line	:	2532 REGATTA AVE
Second Line	:	SUNSET ISLAND 2
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-4235
Country	:	US
Telephone Number	:	305-532-2532
Fax Number	:	305-532-9330

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

Provider Enumeration Date	:	04/28/2008
Last Update Date	:	04/28/2008

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