Provider Demographics
NPI:1780002717
Name:BENNY, LESLIE JACOB (DO)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:JACOB
Last Name:BENNY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:795 PRIMERA BLVD STE 1001
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2191
Mailing Address - Country:US
Mailing Address - Phone:386-561-9967
Mailing Address - Fax:844-815-1446
Practice Address - Street 1:901 E OAK ST STE C
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5837
Practice Address - Country:US
Practice Address - Phone:386-561-9967
Practice Address - Fax:844-815-1446
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS17075207RR0500X
390200000X
WI23400-875207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program