1457677015 NPI number — DR. RON BENTON PITKANEN M.D.

Table of content: DR. RON BENTON PITKANEN M.D. (NPI 1457677015)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457677015 NPI number — DR. RON BENTON PITKANEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PITKANEN
Provider First Name:
RON
Provider Middle Name:
BENTON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457677015
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2700 HIGHWAY 280 S STE 212
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNTAIN BRK
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35223-2468
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-878-4368
Provider Business Mailing Address Fax Number:
855-809-8099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2700 HIGHWAY 280 S STE 212
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTAIN BRK
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35223-2468
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-878-4368
Provider Business Practice Location Address Fax Number:
205-878-4367
Provider Enumeration Date:
04/07/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  34323 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)