Healthcare Provider Details

I. General information

NPI: 1467833509
Provider Name (Legal Business Name): LAREDO PREMIER HEALTHCARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 06/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 GALE ST
LAREDO TX
78041-6003
US

IV. Provider business mailing address

7210 MCPHERSON RD SUITE 115
LAREDO TX
78041-6507
US

V. Phone/Fax

Practice location:
  • Phone: 956-724-9091
  • Fax: 956-724-8213
Mailing address:
  • Phone: 956-722-8046
  • Fax: 956-722-8047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LUIS BENAVIDES
Title or Position: PRESIDENT
Credential: MD
Phone: 956-724-9091