Basic Information
| Provider Information | |||||||||
| NPI: | 1144287459 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PIPERNO | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11945 SAN JOSE BLVD | ||||||||
| Address2: | STE 300 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322231627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043961725 | ||||||||
| FaxNumber: | 9043964893 | ||||||||
| Practice Location | |||||||||
| Address1: | 14540 OLD SAINT AUGUSTINE RD | ||||||||
| Address2: | SUITE 2571 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322587418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048862251 | ||||||||
| FaxNumber: | 9048867151 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2006 | ||||||||
| LastUpdateDate: | 06/23/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | ME92324 | FL | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 296765 | 01 | AVMED | OTHER | 3200862 | 01 | CIGNA | OTHER | 03438 | 01 | BCBS FL | OTHER | P00246913 | 01 | FL | RAILROAD MEDICARE | OTHER | 7340021 | 01 | AETNA | OTHER | 274942400 | 05 | FL | MEDICAID |