Provider Demographics
NPI:1811199268
Name:EDOUARD, BENITO (MD)
Entity Type:Individual
Prefix:DR
First Name:BENITO
Middle Name:
Last Name:EDOUARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 NE 179TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33162-1134
Mailing Address - Country:US
Mailing Address - Phone:305-493-2125
Mailing Address - Fax:
Practice Address - Street 1:725 NE 179TH TERR
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BCH
Practice Address - State:FL
Practice Address - Zip Code:33162-1134
Practice Address - Country:US
Practice Address - Phone:305-493-2125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN213208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice