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NPI Code Detail

MEDICARE: BRYCE I. BENBOW DO

MEDICARE: BRYCE I. BENBOW DO
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
1207XS0117XOrthopaedic Surgery of the Spine PhysicianK5453TX

General Provider Information

NPI Number : 1619011053
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRYCE I. BENBOW DO
Provider Business Mailing Address
First Line : 10400 N CENTRAL EXPY
Second Line :
City : DALLAS
State : TX
Zip : 75231-2297
Country : US
Telephone Number : 972-884-4446
Fax Number : 972-884-4401
Provider Business Practice Location Address
First Line : 10400 N CENTRAL EXPY
Second Line :
City : DALLAS
State : TX
Zip : 75231-2297
Country : US
Telephone Number : 972-884-4446
Fax Number : 972-884-4401
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2007
Last Update Date : 02/09/2021

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