Provider Demographics
NPI:1770778151
Name:BENNER, WILLIAM BRUCE (AP)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BRUCE
Last Name:BENNER
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 863407
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-3407
Mailing Address - Country:US
Mailing Address - Phone:941-917-7477
Mailing Address - Fax:941-917-7940
Practice Address - Street 1:929 S TAMIAMI TRL
Practice Address - Street 2:SUITE 206
Practice Address - City:OSPREY
Practice Address - State:FL
Practice Address - Zip Code:34229-9239
Practice Address - Country:US
Practice Address - Phone:941-917-7477
Practice Address - Fax:941-917-7940
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1328171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist