Provider Demographics
NPI:1093124398
Name:FOY, BENJAMIN RYAN (IDC)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:RYAN
Last Name:FOY
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2784 HORNET WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-6421
Mailing Address - Country:US
Mailing Address - Phone:713-576-6715
Mailing Address - Fax:
Practice Address - Street 1:2784 HORNET WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-6421
Practice Address - Country:US
Practice Address - Phone:713-576-6715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians