Provider Demographics
NPI:1730220294
Name:WITHERS, BENJAMIN FRANKLIN III (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:FRANKLIN
Last Name:WITHERS
Suffix:III
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 1:914 MAIN ST
Mailing Address - Street 2:#906
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-6200
Mailing Address - Country:US
Mailing Address - Phone:713-655-1022
Mailing Address - Fax:
Practice Address - Street 1:12000 LAWNDALE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77017-2740
Practice Address - Country:US
Practice Address - Phone:713-321-4868
Practice Address - Fax:713-321-5238
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ55192083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine