Doctor Name: | DR. BENJAMIN B FANN |
NPI Number: | 1255315560 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 33034 |
Business Practice Address: | 838 State Farm Rd Suite 2 Boone, NC - 286075391 |
Business Phone Number: | 8283861001 |
Business Fax Number: | 8283581317 |
Mailing Address: | 838 State Farm Rd, Suite 2 BOONE |
State: | NC |
Postal Code: | 286075391 |
Phone Number: | 8283861001 |
Fax Number: | 8283581317 |
NPI Enumeration Date: | 11/30/2005 |
NPI Last Update Date: | 07/19/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 33034 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |