Provider Demographics
NPI:1669576005
Name:BENDA, WILLIAM JR (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:BENDA
Suffix:JR
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 1:880 NW 13TH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2342
Mailing Address - Country:US
Mailing Address - Phone:561-297-4814
Mailing Address - Fax:
Practice Address - Street 1:880 NW 13TH ST STE 400
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2342
Practice Address - Country:US
Practice Address - Phone:561-297-4814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME122909207P00000X
CAG58815207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACMM70858FOtherMEDICAL
CA00G588150Medicaid
CAAO323ZMedicare PIN
CACMM70858FOtherMEDICAL
CABY969ZMedicare PIN
CA00G588152Medicare PIN