Organization
JOHNNY C. BENJAMIN JR. M.D., PA
Active
Other names
PRO SPINE
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AMANDA P MULLIKIN (ADMIN ASSIST)
(772) 978-7808
Entity
Organization
Contact information
Practice address
1355 37TH ST, SUITE 301, VERO BEACH, FL 32960-7320
(772) 978-7808
(772) 978-9320
Mailing address
1355 37TH ST, SUITE 301, VERO BEACH, FL 32960-7320
(772) 978-7808
(772) 978-9320
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45410
BLUE CROSS BLUE SHIELD FL
FL
Enumeration date
07/04/2006
Last updated
01/06/2016
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