Provider Demographics
NPI:1235424730
Name:J D BENITONE MD FACS PC
Entity Type:Organization
Organization Name:J D BENITONE MD FACS PC
Other - Org Name:J D BENITONE MD PC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BENITONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-274-9046
Mailing Address - Street 1:2144 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-4229
Mailing Address - Country:US
Mailing Address - Phone:901-274-9046
Mailing Address - Fax:901-272-7360
Practice Address - Street 1:2144 MONROE AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-4229
Practice Address - Country:US
Practice Address - Phone:901-274-9046
Practice Address - Fax:901-272-7360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service