Individual
FRED A BENJAMIN IV
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
36 BRENTSHIRE SQ, JACKSON, TN 38305-2245
(731) 664-1717
(731) 664-7114
Mailing address
70 STATE ROUTE 420, HUMBOLDT, TN 38343-5619
(731) 824-1939
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN0000085124
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3622768
—
TN
Enumeration date
08/16/2005
Last updated
07/08/2007
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