Provider Demographics
NPI:1467985671
Name:BENSON, TYLER JOHN LEE (DO)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:JOHN LEE
Last Name:BENSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:90 PARK RD
Mailing Address - Street 2:
Mailing Address - City:NOCONA
Mailing Address - State:TX
Mailing Address - Zip Code:76255-3600
Mailing Address - Country:US
Mailing Address - Phone:940-825-3333
Mailing Address - Fax:940-825-3052
Practice Address - Street 1:90 PARK RD
Practice Address - Street 2:
Practice Address - City:NOCONA
Practice Address - State:TX
Practice Address - Zip Code:76255-3600
Practice Address - Country:US
Practice Address - Phone:940-825-3333
Practice Address - Fax:940-825-3052
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT2828207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine