Provider Demographics
NPI:1417367970
Name:NABERHAUS, BENJAMIN DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:DANIEL
Last Name:NABERHAUS
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 1:3600 GASTON AVE
Mailing Address - Street 2:WADLEY 550
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1905
Mailing Address - Country:US
Mailing Address - Phone:469-800-7974
Mailing Address - Fax:
Practice Address - Street 1:3600 GASTON AVE
Practice Address - Street 2:WADLEY 550
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246
Practice Address - Country:US
Practice Address - Phone:469-800-7974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXQ2907207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program