Individual
DR. BENJAMIN REED NETTLETON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
5005 PORT ST JOHN PKWY, SUITE 2500, PORT ST JOHN, FL 32927-4305
(321) 504-0556
(321) 504-0773
Mailing address
805 CENTURY MEDICAL DR, CREDENTIALING OFFICE, TITUSVILLE, FL 32796-2100
(321) 268-6264
(321) 268-6273
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
OP0077518
WA
207Q00000X
Family Medicine Physician
Primary
OS13715
FL
207Q00000X
Family Medicine Physician
OT011289
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019231000
—
FL
01
—
249449
LABOR & INDUSTRIES
WA
05
—
8544645
—
WA
Enumeration date
05/01/2008
Last updated
01/04/2017
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