Provider Demographics
NPI:1629063912
Name:BENCOWITZ, HAROLD Z (MD)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:Z
Last Name:BENCOWITZ
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 1:3030 NORTH ST
Mailing Address - Street 2:SUITE 510
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1433
Mailing Address - Country:US
Mailing Address - Phone:409-896-5000
Mailing Address - Fax:409-896-5926
Practice Address - Street 1:3030 NORTH ST
Practice Address - Street 2:SUITE 510
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1433
Practice Address - Country:US
Practice Address - Phone:409-896-5000
Practice Address - Fax:409-896-5926
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR1810207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP082Z1106Medicaid
TXP082Z1106Medicaid
A36920Medicare UPIN