Provider Demographics
NPI:1265464168
Name:BENJAMIN, JOHNNY C JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:C
Last Name:BENJAMIN
Suffix:JR
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 1:1355 37TH ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-7320
Mailing Address - Country:US
Mailing Address - Phone:772-978-7808
Mailing Address - Fax:772-978-9320
Practice Address - Street 1:1355 37TH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-7320
Practice Address - Country:US
Practice Address - Phone:772-978-7808
Practice Address - Fax:772-978-9320
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0070165207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL200040285OtherRAILROAD MEDICARE
FL250692100Medicaid
FL28917OtherBLUE CROSS BLUE SHIELD FL
FL4295190001OtherPALMETTO
FL593604327OtherCHAMPUS
FL250692100Medicaid
FL4295190001OtherPALMETTO