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General NPI Number Information
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NPI Number | 1467833509
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Entity Type | Organization
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Legal Business Name | LAREDO PREMIER HEALTHCARE, PLLC
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Dates
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Enumeration Date | 06/15/2015
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Last Update Date | 06/15/2015
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Provider Practice Location Address
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Address Line | 506 GALE ST
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City | LAREDO
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State | TX
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Zip | 78041-6003
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Country | US
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Telephone | 956-724-9091
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Fax | 956-724-8213
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Provider Business Mailing Address
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Address Line | 7210 MCPHERSON RD SUITE 115
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City | LAREDO
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State | TX
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Zip | 78041-6507
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Country | US
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Telephone | 956-722-8046
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Fax | 956-722-8047
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LUIS BENAVIDES
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Credential | MD
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Telephone | 956-724-9091
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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