MEDICARE: BENJAMIN ANDREW DEATON 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	207L00000X	Anesthesiology Physician	M1623	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	M1623	OTHER	TX	TEXAS STATE LICENSE

General Provider Information

NPI Number	:	1255375119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN ANDREW DEATON M.D.

Provider Business Mailing Address
First Line	:	4438 LEELAND ST
Second Line	:	APT 3
City	:	HOUSTON
State	:	TX
Zip	:	77023-3044
Country	:	US
Telephone Number	:	832-242-1200
Fax Number	:

Provider Business Practice Location Address
First Line	:	4800 FEDERAL PLZ
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77092-1704
Country	:	US
Telephone Number	:	281-580-9030
Fax Number	:	281-580-2725

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	04/15/2021

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