Provider Demographics
NPI:1134270077
Name:BENJAMIN, JAMES REGINALD (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:REGINALD
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 71 STREET
Mailing Address - Street 2:SUITE 620
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3089
Mailing Address - Country:US
Mailing Address - Phone:305-866-9951
Mailing Address - Fax:877-284-8933
Practice Address - Street 1:300 71 STREET
Practice Address - Street 2:SUITE 620
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-3089
Practice Address - Country:US
Practice Address - Phone:305-866-9951
Practice Address - Fax:877-284-8933
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2010-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0026698207Q00000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC88850Medicare UPIN
DC416364ZBDDMedicare PIN
MD178033ZBLJMedicare PIN