Provider Demographics
NPI:1285908491
Name:BELDOCK, BENJAMIN (LMT)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:BELDOCK
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-4441
Mailing Address - Country:US
Mailing Address - Phone:850-425-5009
Mailing Address - Fax:
Practice Address - Street 1:203 OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-4441
Practice Address - Country:US
Practice Address - Phone:850-425-5009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA#9951225700000X
NY010402-1225700000X
MA1173225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC5292OtherBLUECROSS/BLUESHIELD