Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0120X | Pediatric Surgery | PA08269 | TX |
NPI | 1235478645 |
---|---|
Provider Name | Ansley Benson |
First Address | Webster, TX 77598-4234 |
Second Address | Dallas, TX 75251-2116 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2013 |
Last Update Date | 04/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1235478645 | (05) | TX |