Provider Demographics
NPI:1447673132
Name:BENEDICT, MATTHEW (PA-C)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:BENEDICT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10239 COUNTY ROAD 319
Mailing Address - Street 2:
Mailing Address - City:CROSS TIMBERS
Mailing Address - State:MO
Mailing Address - Zip Code:65634-8430
Mailing Address - Country:US
Mailing Address - Phone:417-576-1726
Mailing Address - Fax:
Practice Address - Street 1:10239 COUNTY ROAD 319
Practice Address - Street 2:
Practice Address - City:CROSS TIMBERS
Practice Address - State:MO
Practice Address - Zip Code:65634-8430
Practice Address - Country:US
Practice Address - Phone:417-576-1726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014002425363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant