MEDICARE: DAVID R. BENAVIDES M.D., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	N2941	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255648978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID R. BENAVIDES M.D., P.A.

Provider Business Mailing Address
First Line	:	6930 SPRINGFIELD AVE
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78041-2312
Country	:	US
Telephone Number	:	956-728-8999
Fax Number	:

Provider Business Practice Location Address
First Line	:	6930 SPRINGFIELD AVE
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78041-2312
Country	:	US
Telephone Number	:	956-728-8999
Fax Number	:

Authorized Official
Title or Position	:	C.E.O
Name	:	DAVID R. BENAVIDES
Credential	:	MD
Telephone Number	:	956-728-8999

Provider Enumeration Date	:	09/01/2010
Last Update Date	:	12/21/2011

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