Provider Demographics
NPI:1619011053
Name:BENBOW, BRYCE I (DO)
Entity Type:Individual
Prefix:
First Name:BRYCE
Middle Name:I
Last Name:BENBOW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 N CENTRAL EXPY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-2297
Mailing Address - Country:US
Mailing Address - Phone:972-884-4446
Mailing Address - Fax:972-884-4401
Practice Address - Street 1:10400 N CENTRAL EXPY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-2297
Practice Address - Country:US
Practice Address - Phone:972-884-4446
Practice Address - Fax:972-884-4401
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5453207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
610137Medicare PIN
TXH98208Medicare UPIN