Provider Demographics
NPI:1063445666
Name:BENEVENTO, LOUIS M (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:M
Last Name:BENEVENTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3961 E LOHMAN AVE STE 33
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8440
Mailing Address - Country:US
Mailing Address - Phone:575-522-0423
Mailing Address - Fax:575-556-0201
Practice Address - Street 1:3961 E LOHMAN AVE STE 33
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8440
Practice Address - Country:US
Practice Address - Phone:575-522-0423
Practice Address - Fax:575-556-0201
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM723207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM02428Medicaid
NM02428Medicaid
NM$$$$$$$$$Medicare PIN