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Individual

DR. BENJAMIN FAIR STORK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO, MPH

Contact information

Practice address
483 N AVIATION BLVD, EL SEGUNDO, CA 90245-2808
(310) 653-2873
Mailing address
483 N AVIATION BLVD, EL SEGUNDO, CA 90245-2808
(310) 653-2873

Taxonomy

Speciality
Code
Description
License number
State
2083A0100X
Aerospace Medicine Physician
02004570A
IN
2083X0100X
Occupational Medicine Physician
Primary
02004570A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
02004570A
MEDICAL LICENSE
IN
Enumeration date
07/15/2013
Last updated
09/04/2025
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