1033114269 NPI number — ALEXANDRU E BENET M.D.

Table of content: ALEXANDRU E BENET M.D. (NPI 1033114269)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033114269 NPI number — ALEXANDRU E BENET M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENET
Provider First Name:
ALEXANDRU
Provider Middle Name:
E
Provider Name Prefix Text:
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:
1033114269
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1336
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANDALUSIA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36420-1223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 MEDICAL PARK DR
Provider Second Line Business Practice Location Address:
STE 2
Provider Business Practice Location Address City Name:
ANDALUSIA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36420-5311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-427-7218
Provider Business Practice Location Address Fax Number:
334-427-4999
Provider Enumeration Date:
06/15/2005

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: 174400000X , with the licence number:  I17944 , 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)

  • Identifier: 51524053 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: P00433132 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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