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General NPI Number Information
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NPI Number | 1780857417
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Entity Type | Organization
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Legal Business Name | MARCO A BENITEZ MDPA
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Dates
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Enumeration Date | 04/02/2008
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Last Update Date | 04/02/2008
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Provider Practice Location Address
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Address Line | 511 GASLIGHT BLVD
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City | LUFKIN
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State | TX
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Zip | 75904-3127
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Country | US
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Telephone | 936-639-2222
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Fax | 936-639-8810
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Provider Business Mailing Address
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Address Line | 511 GASLIGHT BLVD
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City | LUFKIN
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State | TX
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Zip | 75904-3127
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Country | US
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Telephone | 936-639-2222
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Fax | 936-639-8810
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. MARCO A BENITEZ
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Credential | MD
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Telephone | 936-639-2222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | L8616
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License Number State | TX
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