Provider Demographics
NPI:1497387336
Name:DRIGGERS, BENJAMIN CLEVELAND V
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:CLEVELAND
Last Name:DRIGGERS
Suffix:V
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 TIMBER HILL RD
Mailing Address - Street 2:
Mailing Address - City:HENRYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18332-7190
Mailing Address - Country:US
Mailing Address - Phone:570-517-9823
Mailing Address - Fax:
Practice Address - Street 1:207 TIMBER HILL RD
Practice Address - Street 2:
Practice Address - City:HENRYVILLE
Practice Address - State:PA
Practice Address - Zip Code:18332-7190
Practice Address - Country:US
Practice Address - Phone:570-517-9823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-09
Last Update Date:2020-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program