Provider Demographics
NPI:1124229901
Name:FORD-GLANTON, BENERANDA SOPHIA (MD)
Entity Type:Individual
Prefix:DR
First Name:BENERANDA
Middle Name:SOPHIA
Last Name:FORD-GLANTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:301 WEST LINCOLN STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220
Mailing Address - Country:US
Mailing Address - Phone:618-641-5803
Mailing Address - Fax:618-641-5813
Practice Address - Street 1:301 W LINCOLN ST STE 201
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-1901
Practice Address - Country:US
Practice Address - Phone:618-641-5803
Practice Address - Fax:618-641-5813
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036119047208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology