Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 21231 | NE |
NPI | 1033190996 |
---|---|
Provider Name | Dr. David A Benavides |
First Address | Kearney, NE 68847-2944 |
Second Address | Kearney, NE 68847-2944 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E72887 | (02) | NE |