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General NPI Number Information
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NPI Number | 1750666095
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Entity Type | Organization
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Legal Business Name | JOSE B. BENIGNO MEDICAL CLINIC, P.A.
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Dates
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Enumeration Date | 10/19/2011
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Last Update Date | 10/19/2011
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Provider Practice Location Address
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Address Line | 115 W 42ND ST
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City | ODESSA
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State | TX
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Zip | 79764-4001
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Country | US
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Telephone | 432-367-4817
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Fax | 432-367-4813
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Provider Business Mailing Address
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Address Line | 115 W 42ND ST
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City | ODESSA
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State | TX
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Zip | 79764-4001
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Country | US
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Telephone | 432-367-4817
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Fax | 432-367-4813
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Authorized Official
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Title or Position | SECRETARY/PRESIDENT
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Name | JOSE BATO BENIGNO JR.
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Credential | M.D.
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Telephone | 432-367-4817
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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 | K9021
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License Number State | TX
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