Provider Demographics
NPI:1528266863
Name:AMIS, BENJAMIN (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:AMIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3901 MEDICAL PKWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-4027
Mailing Address - Country:US
Mailing Address - Phone:512-960-4590
Mailing Address - Fax:512-452-4590
Practice Address - Street 1:3901 MEDICAL PKWY
Practice Address - Street 2:SUITE 301
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-4027
Practice Address - Country:US
Practice Address - Phone:512-960-4590
Practice Address - Fax:512-452-4590
Is Sole Proprietor?:No
Enumeration Date:2007-07-09
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXP7241207XS0106X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
7488910001Medicare NSC