Provider Demographics
NPI:1225537731
Name:BENEZRA GYNECOLOGY
Entity Type:Organization
Organization Name:BENEZRA GYNECOLOGY
Other - Org Name:BENEZRA GYNECOLOGY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:BENEZRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-975-7407
Mailing Address - Street 1:129 W HIBISCUS BOULEVARD SUITE A
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3006
Mailing Address - Country:US
Mailing Address - Phone:321-405-3000
Mailing Address - Fax:321-722-7070
Practice Address - Street 1:129 W HIBISCUS BLVD
Practice Address - Street 2:STE A
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901
Practice Address - Country:US
Practice Address - Phone:321-405-3000
Practice Address - Fax:321-722-7070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-09
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89256207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1QMNMOtherFLORIDA BLUE