Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | MD 0000040290 | TN |
NPI | 1326332768 |
---|---|
Provider Name | Dr. Moses Benaiah Benavides |
First Address | Sevierville, TN 37862-5327 |
Second Address | Sells, AZ 85634-5327 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2011 |
Last Update Date | 26/10/2021 |