Provider Demographics
NPI:1235122896
Name:BENEZRA, VICTOR (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:BENEZRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 W HIBISCUS BLVD STE 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:SUITE A
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3006
Practice Address - Country:US
Practice Address - Phone:321-405-3000
Practice Address - Fax:321-722-7070
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89256207V00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37523OtherFLORIDA BLUE
FL269282100Medicaid
FLP01164043OtherRRMD
FL37523YMedicare PIN