Provider Demographics
NPI:1487645032
Name:BOBON, BENIGNO B (MD)
Entity Type:Individual
Prefix:
First Name:BENIGNO
Middle Name:B
Last Name:BOBON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3505 DULUTH PARK LN
Mailing Address - Street 2:BUILDING 4, STE 400
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-3201
Mailing Address - Country:US
Mailing Address - Phone:678-597-3180
Mailing Address - Fax:678-597-3181
Practice Address - Street 1:3505 DULUTH PARK LN
Practice Address - Street 2:BUILDING 4, STE 400
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3201
Practice Address - Country:US
Practice Address - Phone:678-597-3180
Practice Address - Fax:678-597-3181
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA034303207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11SCFWRMedicare PIN
GAE90163Medicare UPIN