Provider Demographics
NPI:1902007669
Name:BENEZRA, CLIFFORD J (MD)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:J
Last Name:BENEZRA
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 1:2100 E HALLANDALE BEACH BLVD
Mailing Address - Street 2:STE 307
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-3765
Mailing Address - Country:US
Mailing Address - Phone:954-454-9925
Mailing Address - Fax:954-454-9890
Practice Address - Street 1:2100 E HALLANDALE BEACH BLVD
Practice Address - Street 2:STE 307
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-3765
Practice Address - Country:US
Practice Address - Phone:954-454-9925
Practice Address - Fax:954-454-9890
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME038105207R00000X
CAG00035039207R00000X
WV437699207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067531800Medicaid
FLD02547OtherOTHER
FLD47095Medicare UPIN
FL93903Medicare ID - Type UnspecifiedMEDICARE