| Doctor Name: | DR. BENJAMIN JON MORENO |
| NPI Number: | 1013163526 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD, PHD |
| License Number: | 01070072 |
| Business Practice Address: | 620 W Edison Rd Ste 110 Mishawaka, IN - 465452784 |
| Business Phone Number: | 5742581100 |
| Business Fax Number: | 5742581101 |
| Mailing Address: | 620 W Edison Rd, Ste 110 MISHAWAKA |
| State: | IN |
| Postal Code: | 465452784 |
| Phone Number: | 5742581100 |
| Fax Number: | 5742581101 |
| NPI Enumeration Date: | 08/15/2008 |
| NPI Last Update Date: | 05/16/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085R0204X |
| License Number: | 01070072 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IN |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Vascular & Interventional Radiology |
| Taxonomy Definition: | A radiologist who diagnoses and treats diseases by various radiologic imaging modalities. These include fluoroscopy, digital radiography, computed tomography, sonography and magnetic resonance imaging. |