=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053516310
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BENEDICTO CORTES BARONIA M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2007
-----------------------------------------------------
Last Update Date | 08/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3502 9TH ST STE 430
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79415-3368
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-761-0535
-----------------------------------------------------
Fax | 806-761-0534
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5219 CITY BANK PKWY STE 35
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79407-3545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-761-0334
-----------------------------------------------------
Fax | 806-785-0872
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207T00000X
-----------------------------------------------------
Taxonomy Name | Neurological Surgery Physician
-----------------------------------------------------
License Number | 47652
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207T00000X
-----------------------------------------------------
Taxonomy Name | Neurological Surgery Physician
-----------------------------------------------------
License Number | 48359
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------