Provider Demographics
NPI:1588839534
Name:CLAIR, BENJAMIN L (DPM)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:L
Last Name:CLAIR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5803 NEAL AVE N
Mailing Address - Street 2:
Mailing Address - City:OAK PARK HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55082-2177
Mailing Address - Country:US
Mailing Address - Phone:651-439-8807
Mailing Address - Fax:651-439-0232
Practice Address - Street 1:5375 COIT RD STE 100
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-4911
Practice Address - Country:US
Practice Address - Phone:972-712-7773
Practice Address - Fax:972-712-3134
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3121213ES0000X, 213ES0103X
WI1025-25213ES0103X
MN820213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1025-25OtherSTATE LICENSE
MN820OtherMN LICENSE