Individual
BENJAMIN C SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1027 WASHINGTON AVE, DETROIT LAKES, MN 56501-3409
(218) 847-5611
(218) 847-0881
Mailing address
1027 WASHINGTON AVE, DETROIT LAKES, MN 56501-3409
(218) 847-5611
(218) 847-0881
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
104475
MN
2085R0202X
Diagnostic Radiology Physician
Primary
52376
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1831352947
—
MN
01
—
P01206393
RAILROAD MEDICARE
MN
Enumeration date
07/08/2008
Last updated
12/23/2015
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