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General NPI Number Information
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NPI Number | 1821279787
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Entity Type | Organization
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Legal Business Name | BENJAMIN MEDICAL ASSOCIATES, FORNEY. PA
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Dates
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Enumeration Date | 11/20/2007
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Last Update Date | 12/09/2010
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Provider Practice Location Address
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Address Line | 124 E US HIGHWAY 80 STE 104
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City | FORNEY
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State | TX
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Zip | 75126-8612
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Country | US
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Telephone | 972-552-2621
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Fax | 972-552-2620
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Provider Business Mailing Address
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Address Line | 1611 N BELT LINE RD STE A
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City | MESQUITE
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State | TX
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Zip | 75149-1722
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Country | US
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Telephone | 972-613-1000
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Fax | 972-613-4232
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JENSE BENJAMIN
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Credential | MD
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Telephone | 97255222621
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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 | L 2800
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License Number State | TX
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