Healthcare Provider Details

I. General information

NPI: 1437513371
Provider Name (Legal Business Name): MEAGAN VICTORIA BENSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 PENNSYLVANIA AVE STE 600
FORT WORTH TX
76104-2133
US

IV. Provider business mailing address

1325 PENNSYLVANIA AVE STE 600
FORT WORTH TX
76104-2133
US

V. Phone/Fax

Practice location:
  • Phone: 682-267-8694
  • Fax: 817-878-5289
Mailing address:
  • Phone: 682-267-8694
  • Fax: 817-878-5289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberR7170
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberR7170
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: