MEDICARE: DR. BENJAMIN G DIVEN 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	208D00000X	General Practice Physician	8234	NM

General Provider Information

NPI Number	:	1538276142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN G DIVEN MD

Provider Business Mailing Address
First Line	:	CORNER OF STEWART AND BRELAND
Second Line	:	STUDENT HEALTH CENTER, BOX 30001 MSC 3529
City	:	LAS CRUCES
State	:	NM
Zip	:	88003
Country	:	US
Telephone Number	:	505-646-8308
Fax Number	:	505-646-6428

Provider Business Practice Location Address
First Line	:	CORNER OF STEWART AND BRELAND
Second Line	:	STUDENT HEALTH CENTER, BOX 30001 MSC 3529
City	:	LAS CRUCES
State	:	NM
Zip	:	88003
Country	:	US
Telephone Number	:	505-646-8308
Fax Number	:	505-646-6428

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

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	07/08/2007

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