MEDICARE: DR. JUNITHA J BENJAMIN

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	208D00000X	General Practice Physician	L2801	TX
2	207Q00000X	Family Medicine Physician	L2801	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

General Provider Information

NPI Number	:	1912014978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUNITHA J BENJAMIN

Provider Business Mailing Address
First Line	:	125 E GRUBB DR STE 109
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75149-3402
Country	:	US
Telephone Number	:	972-285-6349
Fax Number	:	972-289-6717

Provider Business Practice Location Address
First Line	:	125 E GRUBB DR STE 109
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75149-3402
Country	:	US
Telephone Number	:	972-285-6349
Fax Number	:	972-289-6717

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

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	11/22/2023

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