Provider Demographics
NPI:1265466312
Name:QUIROZ, BENJAMIN RICARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:RICARDO
Last Name:QUIROZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 MEDICAL AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-4739
Mailing Address - Country:US
Mailing Address - Phone:972-867-5100
Mailing Address - Fax:972-867-2580
Practice Address - Street 1:1200 MEDICAL AVE
Practice Address - Street 2:STE 104
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-4739
Practice Address - Country:US
Practice Address - Phone:972-867-5100
Practice Address - Fax:972-867-2580
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7944208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099797501Medicaid
TX099797501Medicaid