Provider Demographics
NPI:1780708909
Name:COUSINS, BENJAMIN JOSEPH III (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:JOSEPH
Last Name:COUSINS
Suffix:III
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 1:4308 ALTON RD STE 720
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-4557
Mailing Address - Country:US
Mailing Address - Phone:786-637-3332
Mailing Address - Fax:866-567-1980
Practice Address - Street 1:4308 ALTON RD STE 720
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-4557
Practice Address - Country:US
Practice Address - Phone:786-637-3332
Practice Address - Fax:866-567-1980
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 115543207XS0106X
FLME115543208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110155502AMedicaid
FL019360500Medicaid
FLME115543OtherMEDICAL LICENSE
MA269487OtherMEDICAL LICENSE