Provider Demographics
NPI:1063455111
Name:AGANA, BENJAMIN T JR (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:T
Last Name:AGANA
Suffix:JR
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:PO BOX 690687
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77269
Mailing Address - Country:US
Mailing Address - Phone:781-586-4100
Mailing Address - Fax:781-580-7083
Practice Address - Street 1:9200 PINECROFT DR
Practice Address - Street 2:STE.# 360
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3279
Practice Address - Country:US
Practice Address - Phone:281-419-3366
Practice Address - Fax:281-419-2233
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4680208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096845503Medicaid
TX8A2610OtherBCBS
TX250012118OtherMEDICARE RAILROAD
TX8A1661Medicare ID - Type Unspecified
TX250012118OtherMEDICARE RAILROAD