Healthcare Provider Details

I. General information

NPI: 1740574144
Provider Name (Legal Business Name): BENJAMIN HUNTLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2011
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 FANNIN ST STE 350
HOUSTON TX
77030-3004
US

IV. Provider business mailing address

6410 FANNIN ST STE 350
HOUSTON TX
77030-3004
US

V. Phone/Fax

Practice location:
  • Phone: 832-325-7131
  • Fax:
Mailing address:
  • Phone: 832-325-7131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License NumberP3896
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0056087
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number503OL33918961
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberP3896
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: