Healthcare Provider Details

I. General information

NPI: 1376886598
Provider Name (Legal Business Name): BENJAMIN WENDELL VORONIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2013
Last Update Date: 12/17/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6411 FANNIN ST
HOUSTON TX
77030-1501
US

IV. Provider business mailing address

2025 MORSE AVE
SACRAMENTO CA
95825-2115
US

V. Phone/Fax

Practice location:
  • Phone: 713-704-4060
  • Fax:
Mailing address:
  • Phone: 916-406-4417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberQ5121
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: