Provider Demographics
NPI:1003894494
Name:BENAVIDES, OSCAR J (MD)
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:J
Last Name:BENAVIDES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3920
Mailing Address - Country:US
Mailing Address - Phone:305-777-9190
Mailing Address - Fax:305-779-0720
Practice Address - Street 1:1193 W 49TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3337
Practice Address - Country:US
Practice Address - Phone:305-777-9190
Practice Address - Fax:305-779-0720
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME99106208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280926500Medicaid
WA8438319Medicaid
I41549Medicare UPIN