Provider Demographics
NPI:1003910720
Name:ZWART, BENTON PHILLIPS (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:BENTON
Middle Name:PHILLIPS
Last Name:ZWART
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 WINDING VW
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-7219
Mailing Address - Country:US
Mailing Address - Phone:210-705-5030
Mailing Address - Fax:210-705-5035
Practice Address - Street 1:2833 BABCOCK, SUITE 105
Practice Address - Street 2:CHRISTUS SANTA ROSA HYPERBARIC AND WOUND CARE CENTER
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-705-5030
Practice Address - Fax:210-705-5035
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK86002083A0100X, 2083P0011X, 2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046692205Medicaid
TX8F8059Medicare PIN