Provider Demographics
NPI:1619266772
Name:SMITH, BENJAMIN CARL
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:CARL
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12201 MERIT DR STE 450
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-3127
Mailing Address - Country:US
Mailing Address - Phone:972-532-3024
Mailing Address - Fax:972-532-3189
Practice Address - Street 1:12201 MERIT DR STE 450
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-3127
Practice Address - Country:US
Practice Address - Phone:972-532-3024
Practice Address - Fax:972-532-3189
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-29
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP7987207VF0040X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive SurgeryGroup - Single Specialty