Provider Demographics
NPI:1497461636
Name:OLIVEIRA, BENEDITO SOARES (PA)
Entity Type:Individual
Prefix:MR
First Name:BENEDITO
Middle Name:SOARES
Last Name:OLIVEIRA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6413 VITEX LN
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-7091
Mailing Address - Country:US
Mailing Address - Phone:508-736-9044
Mailing Address - Fax:
Practice Address - Street 1:15100 RESCUE WAY
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33762-3502
Practice Address - Country:US
Practice Address - Phone:172-753-5143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical