Provider Demographics
NPI:1356338784
Name:BENTON, CHRISTOPHER B (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:B
Last Name:BENTON
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 1:1695 NW 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1409
Mailing Address - Country:US
Mailing Address - Phone:305-355-7777
Mailing Address - Fax:305-355-9201
Practice Address - Street 1:1695 NW 9TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1409
Practice Address - Country:US
Practice Address - Phone:305-355-7777
Practice Address - Fax:305-355-9201
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH9668174400000X
FLME1220532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH81263591Medicaid
NH0108431YONH02OtherBC/BS - BILLING
NH81263591Medicaid
NH0108431YONH02OtherBC/BS - BILLING