Provider Demographics
NPI:1528241700
Name:NEEDHAM, LAILA BENZAKOUR (MD)
Entity type:Individual
Prefix:DR
First Name:LAILA
Middle Name:BENZAKOUR
Last Name:NEEDHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LAILA
Other - Middle Name:BENZAKOUR
Other - Last Name:NEEDHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:300 HEALTH PARK BLVD
Mailing Address - Street 2:SUITE 3002
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-3707
Mailing Address - Country:US
Mailing Address - Phone:904-819-1500
Mailing Address - Fax:904-810-1023
Practice Address - Street 1:300 HEALTH PARK BLVD
Practice Address - Street 2:SUITE 3002
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-3707
Practice Address - Country:US
Practice Address - Phone:904-819-1500
Practice Address - Fax:904-810-1023
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104699207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000947900Medicaid