=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639472210
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GERMAN BENAVIDES, M.D., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2010
-----------------------------------------------------
Last Update Date | 12/21/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7333 BARLITE BLVD STE 310
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78224-1324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-922-3076
-----------------------------------------------------
Fax | 210-922-2672
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7333 BARLITE BLVD STE 310
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78224-1324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-922-3076
-----------------------------------------------------
Fax | 210-922-2672
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DOCTOR
-----------------------------------------------------
Name | DR. GERMAN BENAVIIDES
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 210-922-3076
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | F0877
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------