Individual
DR. BENJAMIN B FANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
838 STATE FARM RD, SUITE 2, BOONE, NC 28607-5391
(828) 386-1001
(828) 358-1317
Mailing address
838 STATE FARM RD, SUITE 2, BOONE, NC 28607-5391
(828) 386-1001
(828) 358-1317
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
33034
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07070484
UHC
NC
01
—
2337582
GROUP
—
01
—
31142
BCBS
NC
05
—
7931142
—
NC
Enumeration date
11/30/2005
Last updated
07/19/2012
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