Provider Demographics
NPI:1962513648
Name:BENJAMIN, DWIGHT EVON (MD, FACOG, FRCOG)
Entity type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:EVON
Last Name:BENJAMIN
Suffix:
Gender:M
Credentials:MD, FACOG, FRCOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:917 CRESTVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33327-1848
Mailing Address - Country:US
Mailing Address - Phone:954-272-8350
Mailing Address - Fax:954-636-2221
Practice Address - Street 1:1951 SW 172ND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-5593
Practice Address - Country:US
Practice Address - Phone:954-435-4700
Practice Address - Fax:954-435-4709
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL90059207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG96825Medicare UPIN