Provider Demographics
NPI:1952744708
Name:BARTSCH, BENJAMIN DAVIES
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:DAVIES
Last Name:BARTSCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 NW 6TH ST
Mailing Address - Street 2:STE F-1
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-2226
Mailing Address - Country:US
Mailing Address - Phone:352-872-2107
Mailing Address - Fax:
Practice Address - Street 1:1411 NW 6TH ST
Practice Address - Street 2:UNIT 120
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-4021
Practice Address - Country:US
Practice Address - Phone:352-519-5106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-11
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL71894171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor