Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | L8616 | TX |
N | 2084N0400X | Neurologist | ME145526 | FL |
NPI | 1013022979 |
---|---|
Provider Name | Marco A Benitez |
First Address | Lufkin, TX 75901-7112 |
Second Address | Lufkin, TX 75901-7112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 01/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
177021601 | (05) | TX |
H39510 | (02) |