Provider Demographics
NPI:1780146191
Name:BENJAMIN, JEFFRY JENSE (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFRY
Middle Name:JENSE
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 1:125 E GRUBB DR STE 109
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-3402
Mailing Address - Country:US
Mailing Address - Phone:972-285-6349
Mailing Address - Fax:972-289-6717
Practice Address - Street 1:125 E GRUBB DR STE 109
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-3402
Practice Address - Country:US
Practice Address - Phone:972-285-6349
Practice Address - Fax:972-289-6717
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT9350207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine