Healthcare Provider Details

I. General information

NPI: 1942359005
Provider Name (Legal Business Name): PATRICIA A BENOIST MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA A EDEN MD

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 11/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1337 S SAM HOUSTON BLVD
HOUSTON MO
65483-2046
US

IV. Provider business mailing address

1337 S SAM HOUSTON BLVD
HOUSTON MO
65483-2046
US

V. Phone/Fax

Practice location:
  • Phone: 417-967-5639
  • Fax: 417-967-5667
Mailing address:
  • Phone: 417-967-5639
  • Fax: 417-967-5667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01063028A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2008016594
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2008016594
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: