Basic Information
Provider Information
NPI: 1073956215
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SWEET
FirstName: BENJAMIN
MiddleName: R
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 COOPER PLZ STE 152
Address2:  
City: CAMDEN
State: NJ
PostalCode: 081031461
CountryCode: US
TelephoneNumber: 8563422627
FaxNumber:  
Practice Location
Address1: 1111 6TH AVE
Address2:  
City: DES MOINES
State: IA
PostalCode: 503142613
CountryCode: US
TelephoneNumber: 5152473121
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/08/2013
LastUpdateDate: 12/08/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000XMD-42772IAY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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