Healthcare Provider Details

I. General information

NPI: 1326277245
Provider Name (Legal Business Name): BENJAMIN ROSS ESKENAZI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 WESTLAKE DR STE 100
WEST LAKE HILLS TX
78746-5373
US

IV. Provider business mailing address

102 WESTLAKE DR STE 100
WEST LAKE HILLS TX
78746-5373
US

V. Phone/Fax

Practice location:
  • Phone: 512-327-7779
  • Fax: 512-444-0977
Mailing address:
  • Phone: 512-327-7779
  • Fax: 512-444-0977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number201700116
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: