Provider Demographics
NPI:1114312261
Name:YOSEPH, BENYAM PETROS (MD)
Entity Type:Individual
Prefix:DR
First Name:BENYAM
Middle Name:PETROS
Last Name:YOSEPH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BEN
Other - Middle Name:PETROS
Other - Last Name:YOSEPH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD PHD
Mailing Address - Street 1:1508 SOFTSHELL ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-7516
Mailing Address - Country:US
Mailing Address - Phone:612-245-4392
Mailing Address - Fax:
Practice Address - Street 1:HOME PHYSICIANS GROUP
Practice Address - Street 2:7620 LAKE UNDERHILL RD
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-3282
Practice Address - Country:US
Practice Address - Phone:321-235-0692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-04
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FL137448208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program