Individual
BENJAMIN PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4881 SUGAR MAPLE DR, WPAFB, OH 45433-5529
(937) 255-4809
Mailing address
4881 SUGAR MAPLE DR, WPAFB, OH 45433-5529
(937) 255-4809
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01062522A
IN
2083A0100X
Aerospace Medicine Physician
Primary
01062522A
IN
Other
Enumeration date
08/05/2006
Last updated
06/09/2025
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