Basic Information
| Provider Information | |||||||||
| NPI: | 1457466971 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TREEN | ||||||||
| FirstName: | BEN | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2230 SW 19TH AVENUE RD | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344711391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522374133 | ||||||||
| FaxNumber: | 3522377728 | ||||||||
| Practice Location | |||||||||
| Address1: | 2121 SW 22ND PL | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344717766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522374133 | ||||||||
| FaxNumber: | 3522377728 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 10/18/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | TP025 | KY | N | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | 30999 | AL | N | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | 068626 | GA | N | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | 13943 | SC | N | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | ME1111720 | FL | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 003131886A | 05 | GA | MEDICAID | 1457466971 | 05 | AL | MEDICAID |