Provider Demographics
NPI:1871275602
Name:HEBRON, BENJAMIN L (ATP)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:L
Last Name:HEBRON
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99283
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-1383
Mailing Address - Country:US
Mailing Address - Phone:682-885-6294
Mailing Address - Fax:682-885-1135
Practice Address - Street 1:1101 W VICKERY BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-1025
Practice Address - Country:US
Practice Address - Phone:682-303-3116
Practice Address - Fax:682-885-5606
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX95823247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other