Provider Demographics
NPI:1497893754
Name:BENAVIDES, RICHARD ALEX (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALEX
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 1:5934 WALNUT HILL LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-5014
Mailing Address - Country:US
Mailing Address - Phone:469-370-7280
Mailing Address - Fax:
Practice Address - Street 1:7920 BELT LINE RD
Practice Address - Street 2:SUITE 310
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-8145
Practice Address - Country:US
Practice Address - Phone:972-331-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9189208D00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U57YMedicare ID - Type Unspecified
TXC78625Medicare UPIN