Healthcare Provider Details

I. General information

NPI: 1689606352
Provider Name (Legal Business Name): THOMAS BRADLEY BENEDICT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 03/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 MEDICAL CENTRE DR STE C
ARLINGTON TX
76012-4700
US

IV. Provider business mailing address

901 MEDICAL CENTRE DR STE C
ARLINGTON TX
76012-4700
US

V. Phone/Fax

Practice location:
  • Phone: 817-277-2202
  • Fax: 817-548-9709
Mailing address:
  • Phone: 817-277-2202
  • Fax: 817-548-9709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberE0809
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: