Provider Demographics
NPI:1871898429
Name:JOSE BENAMU M.D. P.A.
Entity type:Organization
Organization Name:JOSE BENAMU M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-528-4000
Mailing Address - Street 1:1155 GREGORY ST
Mailing Address - Street 2:
Mailing Address - City:TAFT
Mailing Address - State:TX
Mailing Address - Zip Code:78390-3015
Mailing Address - Country:US
Mailing Address - Phone:361-528-4000
Mailing Address - Fax:361-528-3711
Practice Address - Street 1:1155 GREGORY ST
Practice Address - Street 2:
Practice Address - City:TAFT
Practice Address - State:TX
Practice Address - Zip Code:78390-3015
Practice Address - Country:US
Practice Address - Phone:361-528-4000
Practice Address - Fax:361-528-3711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1358207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096267201Medicaid
TX0011CJOtherBLUE CROSS BLUE SHEILD
TX096267201Medicaid
TX0011CJOtherBLUE CROSS BLUE SHEILD