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General NPI Number Information
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NPI Number | 1013022979
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Entity Type | Individual
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Provider Name | MARCO A BENITEZ M.D
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Gender | Male
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 09/01/2021
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Provider Practice Location Address
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Address Line | 3006 S 1ST ST STE B
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City | LUFKIN
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State | TX
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Zip | 75901-7112
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Country | US
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Telephone | 936-639-2222
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Fax | 936-639-8810
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Provider Business Mailing Address
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Address Line | 3006 S 1ST ST STE B
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City | LUFKIN
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State | TX
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Zip | 75901-7112
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Country | US
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Telephone | 936-639-2222
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Fax | 936-639-8810
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | ME145526
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | L8616
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License Number State | TX
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