Healthcare Provider Details

I. General information

NPI: 1770929895
Provider Name (Legal Business Name): JANET BENAVIDEZ EDDY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3723 W 12600 S STE 350
RIVERTON UT
84065-7296
US

IV. Provider business mailing address

1010 N KANSAS ST
WICHITA KS
67214-3124
US

V. Phone/Fax

Practice location:
  • Phone: 801-285-4800
  • Fax:
Mailing address:
  • Phone: 316-293-2665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number9408465
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number10633362-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: