Provider Demographics
NPI:1538171418
Name:BENJAMIN, DENIS R (MD)
Entity type:Individual
Prefix:
First Name:DENIS
Middle Name:R
Last Name:BENJAMIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99371
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0371
Mailing Address - Country:US
Mailing Address - Phone:682-885-4157
Mailing Address - Fax:682-885-7347
Practice Address - Street 1:801 7TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2733
Practice Address - Country:US
Practice Address - Phone:682-885-4289
Practice Address - Fax:682-885-6111
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9728207ZP0102X, 207ZP0213X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0213XAllopathic & Osteopathic PhysiciansPathologyPediatric Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7308123OtherAETNA PIN
TX0083EBOtherBCBSTX GRP PIN
TX108418100OtherFIRSTCARE PIN
TX1750369203OtherGRP NPI NUMBER
TX140442847Medicaid
TX9110676OtherPHCS PIN
TX105722602Medicaid
TX85111YOtherBCBSTX IND PIN
TX124030OtherSUPERIOR PIN
TX9030385OtherCIGNA PIN
TX10030959OtherAMERIGROUP PIN
TX122646OtherUHC PIN
TX140442895Medicaid
TX800011OtherFIRSTHEALTH PIN
TX105722601Medicaid
TX8829J1Medicare PIN
TX800011OtherFIRSTHEALTH PIN
TX1750369203OtherGRP NPI NUMBER
TX140442847Medicaid