Provider Demographics
NPI:1881905438
Name:SMITH, BENJAMIN T (DO)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:T
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26520 CACTUS AVE
Mailing Address - Street 2:C/O GME OFFICE RM. A1005
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-3927
Mailing Address - Country:US
Mailing Address - Phone:951-486-5908
Mailing Address - Fax:951-486-5910
Practice Address - Street 1:26520 CACTUS AVE
Practice Address - Street 2:C/O GME OFFICE RM. A1005
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-3927
Practice Address - Country:US
Practice Address - Phone:951-486-5908
Practice Address - Fax:951-486-5910
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
MT49886207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program