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General NPI Number Information
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NPI Number | 1952495400
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Entity Type | Individual
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Provider Name | BENJAMIN FANO MD
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Gender | Male
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 06/06/2013
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Provider Practice Location Address
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Address Line | 301 W EXPRESSWAY 83 ATTN: MCALLEN HOSPITALIST PROGRAM
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City | MCALLEN
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State | TX
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Zip | 78503-3045
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Country | US
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Telephone | 956-632-4000
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Fax | 956-961-4286
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Provider Business Mailing Address
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Address Line | 1400 W TRENTON RD ATTN: PHYSICIAN PRACTICE ADMINISTRATOR
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City | EDINBURG
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State | TX
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Zip | 78539-3413
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Country | US
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Telephone | 956-388-2207
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Fax | 956-289-5040
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | L0164
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | L0164
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License Number State | TX
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