Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | E7818 | TX |
NPI | 1003818089 |
---|---|
Provider Name | Peter Benjamin |
First Address | Dallas, TX 75284-1969 |
Second Address | Houston, TX 77030-4412 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 26/01/2010 |