Provider Demographics
NPI:1417153701
Name:YAN, BEN (MD)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:
Last Name:YAN
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 1:400 PINELLAS ST STE 220
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3318
Mailing Address - Country:US
Mailing Address - Phone:727-462-3692
Mailing Address - Fax:727-266-4935
Practice Address - Street 1:400 PINELLAS ST
Practice Address - Street 2:SUITE 220
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3318
Practice Address - Country:US
Practice Address - Phone:727-462-3692
Practice Address - Fax:727-266-4935
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301089844207R00000X
FLME113457207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006425400Medicaid
FL006425400Medicaid
FLGM876ZMedicare PIN