Provider Demographics
NPI:1992719686
Name:SANPEDRO, BENEDICTO P (MD)
Entity type:Individual
Prefix:DR
First Name:BENEDICTO
Middle Name:P
Last Name:SANPEDRO
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 1:3731 LAKE WORTH ROAD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461
Mailing Address - Country:US
Mailing Address - Phone:561-967-0234
Mailing Address - Fax:561-439-4833
Practice Address - Street 1:3731 LAKE WORTH ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461
Practice Address - Country:US
Practice Address - Phone:561-967-0234
Practice Address - Fax:561-439-4833
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0029312171W00000X
FLME29312207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL058858000Medicaid
FL058858000Medicaid
FL79040Medicare ID - Type Unspecified