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1063404036
FRED A BENJAMIN IV
JACKSON, TN
NPI
1063404036
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
163W00000X Registered Nurse
(Licence: TN RN0000085124)
Enumeration Date
2005-08-16
Last Update Date
2007-07-08
Business Address
-- FRED A BENJAMIN IV CRNA
36 BRENTSHIRE SQ
JACKSON, TN 38305-2245
Phone number: 731-664-1717
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Mailing Address
-- FRED A BENJAMIN IV CRNA
70 STATE ROUTE 420
HUMBOLDT, TN 38343-5619
Phone number: 731-824-1939
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