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General NPI Number Information
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NPI Number | 1790304517
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Entity Type | Individual
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Provider Name | BENNIE PADGETT MD
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Gender | Male
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Dates
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Enumeration Date | 04/12/2020
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Last Update Date | 07/24/2024
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Provider Practice Location Address
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Address Line | 5615 H MARK CROSSWELL JR ST
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City | HOUSTON
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State | TX
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Zip | 77021-1080
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Country | US
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Telephone | 803-640-0678
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Fax |
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Provider Business Mailing Address
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Address Line | 625 19TH ST S
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City | BIRMINGHAM
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State | AL
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Zip | 35233-1900
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Country | US
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Telephone |
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | V0498
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License Number State | TX
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