MEDICARE: JAIME C BENTON MD

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	M0619	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	M0619	OTHER	TX	PHYSICIAN PERMIT

General Provider Information

NPI Number	:	1700878311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAIME C BENTON MD

Provider Business Mailing Address
First Line	:	PO BOX 844658
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-4658
Country	:	US
Telephone Number	:	254-724-2111
Fax Number	:

Provider Business Practice Location Address
First Line	:	8264 HIGHWAY 6 LOOP
Second Line	:
City	:	NAVASOTA
State	:	TX
Zip	:	77868-3292
Country	:	US
Telephone Number	:	979-207-6100
Fax Number	:

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	08/20/2024

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Directions to “ JAIME C BENTON MD” Practice Location

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