Provider Demographics
NPI:1104209758
Name:JAN S BENDER MD, PLLC
Entity Type:Organization
Organization Name:JAN S BENDER MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:STEWART
Authorized Official - Last Name:BENDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-347-2557
Mailing Address - Street 1:6449 38TH AVE N STE G4
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1643
Mailing Address - Country:US
Mailing Address - Phone:727-347-2557
Mailing Address - Fax:
Practice Address - Street 1:6449 38TH AVE N STE G4
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1643
Practice Address - Country:US
Practice Address - Phone:727-347-2557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL55667208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty