Benjamin Mark Shore, D.O.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

OS-0003915 Issued in FL

Practice address

2532 Regatta Ave
Sunset Island 2
Miami Beach, FL 33140-4235

Phone

(305) 532-2532

Fax

(305) 532-9330

NPI assigned

Apr 28, 2008

Last updated

Apr 28, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Osteopathy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1209340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209340800000",
    "number": "1619142957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2532 REGATTA AVE",
            "address_2": "SUNSET ISLAND 2",
            "city": "MIAMI BEACH",
            "state": "FL",
            "postal_code": "331404235",
            "telephone_number": "305-532-2532",
            "fax_number": "305-532-9330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2532 REGATTA AVE",
            "address_2": "SUNSET ISLAND 2",
            "city": "MIAMI BEACH",
            "state": "FL",
            "postal_code": "331404235",
            "telephone_number": "305-532-2532",
            "fax_number": "305-532-9330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHORE",
        "first_name": "BENJAMIN",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-04-28",
        "last_updated": "2008-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "OS-0003915",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "OS-0003915",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06625429900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Emergency Medicine Physician in Miami Beach, FL
• Providers in Miami Beach, FL by specialty
• Emergency Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.