MEDICARE: DR. TERRELL BENOLD 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	207Q00000X	Family Medicine Physician	G4822	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245252576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRELL BENOLD M.D.

Provider Business Mailing Address
First Line	:	1601 RIO GRANDE ST STE 340
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78701-1162
Country	:	US
Telephone Number	:	512-324-7318
Fax Number	:	512-324-8018

Provider Business Practice Location Address
First Line	:	1313 RED RIVER ST STE 100
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78701-1923
Country	:	US
Telephone Number	:	512-324-8600
Fax Number	:	512-324-8616

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	10/05/2012

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