Provider Demographics
NPI:1922010008
Name:BENDER, KEVIN ROSS (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ROSS
Last Name:BENDER
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 1:7707 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2950
Mailing Address - Country:US
Mailing Address - Phone:954-722-4206
Mailing Address - Fax:954-722-4226
Practice Address - Street 1:7707 N UNIVERSITY DR
Practice Address - Street 2:SUITE 106
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2950
Practice Address - Country:US
Practice Address - Phone:954-722-4206
Practice Address - Fax:954-722-4226
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66657207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375775700Medicaid
FL25655VOtherMEDICARE PTAN
FL375775700Medicaid