| Doctor Name: | BENJAMIN PARK |
| NPI Number: | 1144239740 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 01062522A |
| Business Practice Address: | 2510 5th St Bldg 20-840 Wright Patterson Afb, OH - 454337913 |
| Business Phone Number: | 9379382744 |
| Business Fax Number: | 9379046330 |
| Mailing Address: | 2510 5th St Bldg 20-840, WRIGHT PATTERSON AFB |
| State: | OH |
| Postal Code: | 454337913 |
| Phone Number: | 9379382744 |
| Fax Number: | 9379046330 |
| NPI Enumeration Date: | 08/05/2006 |
| NPI Last Update Date: | 11/26/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 01062522A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |