Provider Demographics
NPI:1124190921
Name:BENJAMIN, DEBBIE K
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:K
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 N 4240 RD
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:OK
Mailing Address - Zip Code:74743-6903
Mailing Address - Country:US
Mailing Address - Phone:580-326-2535
Mailing Address - Fax:580-326-2535
Practice Address - Street 1:922 N 4240 RD
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-6903
Practice Address - Country:US
Practice Address - Phone:580-326-2535
Practice Address - Fax:580-326-2535
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK177F00000X177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging