MEDICARE: BENJAMIN D PITMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	26331	OK
2	207L00000X	Anesthesiology Physician	26331	OK

General Provider Information

NPI Number	:	1114187416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN D PITMAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 840848
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-0848
Country	:	US
Telephone Number	:	972-715-5000
Fax Number	:	972-715-9976

Provider Business Practice Location Address
First Line	:	1200 NE 13TH
Second Line	:	OKLA. COUNTY CRISIS INTERVENTION CENTER
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73152
Country	:	US
Telephone Number	:	405-522-8150
Fax Number	:	405-522-4120

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2008
Last Update Date	:	05/22/2018

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