Moreno, Benjamin Jon

Moreno, Benjamin Jon is an individual health care provider with primary practice located at 3707 New Vision Dr Ste 110 , Fort Wayne IN 46845-1702. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology, Allopathic & Osteopathic Physicians / Diagnostic Radiology. Allopathic & Osteopathic Physicians / Diagnostic Radiology is his primary health care specialty. Moreno, Benjamin Jon can be contacted via phone (260) 469-6602.

Contact Information

Primary practice address
3707 New Vision Dr Ste 110 Fort Wayne IN 46845-1702
Phone: (260) 469-6602
Fax: (260) 484-5919
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology 2085R0204X 01070072 Indiana
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 01070072 Indiana

Profile Details

NPI number 1013163526
LBN Legal business name Moreno, Benjamin Jon
Credentials MD, PHD
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 15th, 2008
Last updated Mar 5th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1013163526 NPPES
Indiana MEDICAID 201028590

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