Provider Demographics
NPI:1982630786
Name:JEAN-BENOIT, MARIE VICTOIRE (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:VICTOIRE
Last Name:JEAN-BENOIT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:VICTOIRE
Other - Last Name:JEAN-BENOIT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:4064 NW 62ND LN
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-3217
Mailing Address - Country:US
Mailing Address - Phone:954-346-3668
Mailing Address - Fax:954-346-3668
Practice Address - Street 1:4064 NW 62ND LN
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-3217
Practice Address - Country:US
Practice Address - Phone:954-346-3668
Practice Address - Fax:954-346-3668
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2959213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340355600Medicaid
FL480032997OtherRAILROAD MEDICARE
FL340355600Medicaid
FL480032997OtherRAILROAD MEDICARE