Provider Demographics
NPI:1538185046
Name:BENODIN, LESLY (MD)
Entity type:Individual
Prefix:DR
First Name:LESLY
Middle Name:
Last Name:BENODIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LES
Other - Middle Name:
Other - Last Name:BENODIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7026 OLD KATY RD
Mailing Address - Street 2:SUITE 276
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2133
Mailing Address - Country:US
Mailing Address - Phone:713-621-7436
Mailing Address - Fax:713-963-9051
Practice Address - Street 1:7026 OLD KATY RD
Practice Address - Street 2:SUITE 276
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2133
Practice Address - Country:US
Practice Address - Phone:713-621-7436
Practice Address - Fax:713-963-9051
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH126402085R0202X
TXN93532085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1012360Medicaid
NH30205855Medicaid
TXTBX161332OtherMEDICARE PTAN
VT1012360Medicaid
TXTBX161332OtherMEDICARE PTAN