Healthcare Provider Details

I. General information

NPI: 1326061086
Provider Name (Legal Business Name): KEVIN BENSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 JBS PKWY
ODESSA TX
79762-8126
US

IV. Provider business mailing address

PO BOX 2129
ODESSA TX
79760-2129
US

V. Phone/Fax

Practice location:
  • Phone: 432-640-6772
  • Fax: 432-640-4708
Mailing address:
  • Phone: 432-640-6600
  • Fax: 432-640-4791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberQ5759
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: