Provider Demographics
NPI:1497018345
Name:OSTERRIEDER, BENJAMIN DAVID (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:DAVID
Last Name:OSTERRIEDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2699
Mailing Address - Street 2:ATTN: SHMG/HPE
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-416-5050
Mailing Address - Fax:850-416-5022
Practice Address - Street 1:3754 HIGHWAY 90
Practice Address - Street 2:STE 220
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-1096
Practice Address - Country:US
Practice Address - Phone:850-416-5050
Practice Address - Fax:850-416-5022
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME124744207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology