Healthcare Provider Details

I. General information

NPI: 1609982453
Provider Name (Legal Business Name): EDDIE G BENGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 LANG AVE NE
ALBUQUERQUE NM
87109
US

IV. Provider business mailing address

4901 LANG AVE NE
ALBUQUERQUE NM
87109
US

V. Phone/Fax

Practice location:
  • Phone: 505-822-1309
  • Fax: 505-822-1393
Mailing address:
  • Phone: 505-822-1309
  • Fax: 505-822-1393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number8114
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: