Individual
BENJAMIN GRANT MARSHALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1785 GARDEN ST, TITUSVILLE, FL 32796-3221
(321) 269-9612
(321) 269-8433
Mailing address
1785 GARDEN ST, TITUSVILLE, FL 32796-3221
(213) 269-9612
(321) 268-8433
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
MD208003
LA
207Q00000X
Family Medicine Physician
Primary
TRN 17849
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LS576
PTAN
FL
01
—
ME118384
MEDICAL LICENSE
FL
Enumeration date
06/07/2012
Last updated
01/04/2021
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