Provider Demographics
NPI:1407802093
Name:BENZ, KAREN LAITNER (DO)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:LAITNER
Last Name:BENZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 8TH AVE STE 270
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4139
Mailing Address - Country:US
Mailing Address - Phone:817-725-7900
Mailing Address - Fax:817-335-4418
Practice Address - Street 1:1250 8TH AVE
Practice Address - Street 2:SUITE 270
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4124
Practice Address - Country:US
Practice Address - Phone:817-927-9100
Practice Address - Fax:817-927-9103
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4243207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX511917YSE6Medicare PIN
TXH88965Medicare UPIN
TXH88965Medicare UPIN