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General NPI Number Information
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NPI Number | 1265228951
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Entity Type | Organization
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Legal Business Name | ERIC SIDARIS BENNOS MD PA
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Dates
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Enumeration Date | 04/17/2025
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 6000 BAY PARK CT
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City | FLOWER MOUND
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State | TX
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Zip | 75022-5576
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Country | US
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Telephone | 972-358-0426
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Fax | 972-539-6485
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Provider Business Mailing Address
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Address Line | PO BOX 271387
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City | FLOWER MOUND
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State | TX
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Zip | 75027-1387
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Country | US
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Telephone | 972-358-0426
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Fax | 972-539-6485
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. ERIC SIDARIS BENNOS, MD
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Credential | MD
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Telephone | 817-243-2432
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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