Individual
THOMAS BB BENTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5612 NW 43RD ST, GAINESVILLE, FL 32653-3332
(352) 376-4542
(352) 376-4959
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(352) 376-4542
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME53353
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
048463600
—
FL
01
—
OB157
MEDICARE HF
FL
Enumeration date
01/30/2006
Last updated
09/08/2021
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