Individual
DR. BENJAMIN RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
AU.D.
Contact information
Practice address
4202 E FOWLER AVE, PCD1017, TAMPA, FL 33620-8200
(813) 974-8804
Mailing address
4202 E FOWLER AVE, PCD1017, TAMPA, FL 33620-8200
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
AY1685
FL
Other
Enumeration date
07/25/2013
Last updated
07/25/2013
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