MEDICARE: DR. EDCHERIL BENNY MD

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	2084N0400X	Neurology Physician	MD0000030955	TN
2	2084N0400X	Neurology Physician	N1260	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0191134	OTHER	TN	CIGNA
2	3106691	OTHER	TN	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376656728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDCHERIL BENNY MD

Provider Business Mailing Address
First Line	:	2100 WEST LOOP S
Second Line	:	SUITE 100
City	:	HOUSTON
State	:	TX
Zip	:	77027-3515
Country	:	US
Telephone Number	:	713-590-2700
Fax Number	:	713-590-2702

Provider Business Practice Location Address
First Line	:	2100 WEST LOOP S
Second Line	:	SUITE100
City	:	HOUSTON
State	:	TX
Zip	:	77027-3515
Country	:	US
Telephone Number	:	713-590-2700
Fax Number	:	713-590-2702

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	06/12/2012

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