Provider Demographics
NPI:1184800948
Name:BENJAMIN, DELANO (MD)
Entity type:Individual
Prefix:
First Name:DELANO
Middle Name:
Last Name:BENJAMIN
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 1:1480 FORESTDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORESTDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35214-3034
Mailing Address - Country:US
Mailing Address - Phone:205-820-9050
Mailing Address - Fax:205-820-9060
Practice Address - Street 1:1480 FORESTDALE BLVD
Practice Address - Street 2:
Practice Address - City:FORESTDALE
Practice Address - State:AL
Practice Address - Zip Code:35214-3034
Practice Address - Country:US
Practice Address - Phone:205-820-9050
Practice Address - Fax:205-820-9060
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.24889207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine