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General NPI Number Information
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NPI Number | 1336140474
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Entity Type | Individual
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Provider Name | BENJAMIN WILSON COVINGTON IV M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/10/2005
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Last Update Date | 01/28/2013
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Provider Practice Location Address
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Address Line | 730 EUREKA ST
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City | WEATHERFORD
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State | TX
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Zip | 76086-6546
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Country | US
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Telephone | 817-514-6193
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Fax | 817-514-6947
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Provider Business Mailing Address
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Address Line | PO BOX 26804
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City | BENBROOK
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State | TX
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Zip | 76126-0804
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Country | US
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Telephone | 817-514-6193
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Fax | 817-514-6947
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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 | L5709
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | L5709
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | L5709
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License Number State | TX
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