Provider Demographics
NPI:1376887307
Name:BENCH, CALLIE D (LM)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:D
Last Name:BENCH
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 ALOMA AVE
Mailing Address - Street 2:E-2
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-7133
Mailing Address - Country:US
Mailing Address - Phone:407-461-5127
Mailing Address - Fax:
Practice Address - Street 1:7200 ALOMA AVE
Practice Address - Street 2:E-2
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-7133
Practice Address - Country:US
Practice Address - Phone:407-461-5127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW 269176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife