Provider Demographics
NPI:1134794688
Name:CAMPOS, BENJAMIN (PA-C)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:
Last Name:CAMPOS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 E AUSTIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-4170
Mailing Address - Country:US
Mailing Address - Phone:830-832-2457
Mailing Address - Fax:830-620-4908
Practice Address - Street 1:189 E AUSTIN ST STE 102
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-4170
Practice Address - Country:US
Practice Address - Phone:830-832-2457
Practice Address - Fax:830-620-4908
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14617207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine