MEDICARE: DR. JEFFRY JENSE BENJAMIN 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	207Q00000X	Family Medicine Physician	T9350	TX

General Provider Information

NPI Number	:	1780146191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFRY JENSE BENJAMIN MD

Provider Business Mailing Address
First Line	:	125 E GRUBB DR STE 109
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75149-3402
Country	:	US
Telephone Number	:	972-285-6349
Fax Number	:	972-289-6717

Provider Business Practice Location Address
First Line	:	125 E GRUBB DR STE 109
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75149-3402
Country	:	US
Telephone Number	:	972-285-6349
Fax Number	:	972-289-6717

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

Provider Enumeration Date	:	04/03/2019
Last Update Date	:	07/01/2024

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