Individual
DR. BENJAMIN FAIR STORK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO, MPH
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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