Provider Demographics
NPI:1356493977
Name:BENAVIDES, OSCAR (MD)
Entity Type:Individual
Prefix:
First Name:OSCAR
Middle Name:
Last Name:BENAVIDES
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 1:209 W VILLAGE BLVD
Mailing Address - Street 2:STE 11
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-2227
Mailing Address - Country:US
Mailing Address - Phone:956-725-5210
Mailing Address - Fax:956-717-1708
Practice Address - Street 1:209 W VILLAGE BLVD
Practice Address - Street 2:STE 11
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-2227
Practice Address - Country:US
Practice Address - Phone:956-725-5210
Practice Address - Fax:956-717-1708
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9039207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1371882-02Medicaid
TX1924631-01Medicaid
E23632Medicare UPIN
TX1924631-01Medicaid
TX8375J9Medicare PIN