Provider Demographics
NPI:1487718102
Name:HARRIMAN, BEN B (MD)
Entity type:Individual
Prefix:
First Name:BEN
Middle Name:B
Last Name:HARRIMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 550059
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33655-0059
Mailing Address - Country:US
Mailing Address - Phone:727-462-7062
Mailing Address - Fax:
Practice Address - Street 1:323 JEFFORDS ST # MS -32
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3825
Practice Address - Country:US
Practice Address - Phone:727-462-7062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME33263173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD57336Medicare UPIN
FL62187ZMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL ID