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General NPI Number Information
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NPI Number | 1235424730
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Entity Type | Organization
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Legal Business Name | J D BENITONE MD FACS PC
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Dates
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Enumeration Date | 06/13/2011
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Last Update Date | 06/13/2011
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Provider Practice Location Address
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Address Line | 2144 MONROE AVE
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City | MEMPHIS
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State | TN
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Zip | 38104-4229
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Country | US
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Telephone | 901-274-9046
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Fax | 901-272-7360
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Provider Business Mailing Address
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Address Line | 2144 MONROE AVE
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City | MEMPHIS
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State | TN
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Zip | 38104-4229
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Country | US
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Telephone | 901-274-9046
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Fax | 901-272-7360
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JERRY D BENITONE
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Credential | M.D.
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Telephone | 901-274-9046
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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