Provider Demographics
NPI:1588928980
Name:STUDDARD, BENJAMIN (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:STUDDARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 WILLIAMS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-3287
Mailing Address - Country:US
Mailing Address - Phone:615-890-5484
Mailing Address - Fax:615-890-7924
Practice Address - Street 1:1617 WILLIAMS DR STE 200
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-3287
Practice Address - Country:US
Practice Address - Phone:615-890-5484
Practice Address - Fax:615-890-7924
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN55792207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ029697Medicaid