Provider Demographics
NPI:1518470384
Name:CHISM, BENJAMIN GREGORY JR (BSBME, CCDS, CEPS)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:GREGORY
Last Name:CHISM
Suffix:JR
Gender:M
Credentials:BSBME, CCDS, CEPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3644 BILTMORE AVE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-5701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3644 BILTMORE AVE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32311-5701
Practice Address - Country:US
Practice Address - Phone:904-238-3770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZB0301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherBiomedical Engineering