Provider Demographics
NPI:1306180096
Name:SCARBRO, BENJAMIN SCOTT (CRNA)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:SCOTT
Last Name:SCARBRO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 741475
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75374-1475
Mailing Address - Country:US
Mailing Address - Phone:214-373-9092
Mailing Address - Fax:214-373-9250
Practice Address - Street 1:11910 GREENVILLE AVE
Practice Address - Street 2:SUITE 650
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3596
Practice Address - Country:US
Practice Address - Phone:214-373-9092
Practice Address - Fax:214-373-9250
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX125714367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered