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General NPI Number Information
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NPI Number | 1194919639
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Entity Type | Individual
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Provider Name | EDGARDO BENAVIDES D.O.
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Gender | Male
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Dates
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Enumeration Date | 08/28/2007
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Last Update Date | 03/22/2021
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Provider Practice Location Address
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Address Line | 12650 NACOGDOCHES RD
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City | SAN ANTONIO
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State | TX
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Zip | 78217-2118
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Country | US
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Telephone | 210-656-4363
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Fax | 210-599-1251
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Provider Business Mailing Address
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Address Line | 7500 BARLITE BLVD STE 313
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City | SAN ANTONIO
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State | TX
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Zip | 78224-1363
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Country | US
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Telephone | 210-928-2273
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Fax | 210-928-7272
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | M7037
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License Number State | TX
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