Provider Demographics
NPI:1689606352
Name:BENEDICT, THOMAS BRADLEY (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:BRADLEY
Last Name:BENEDICT
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 1:901 MEDICAL CENTRE DR STE C
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-4700
Mailing Address - Country:US
Mailing Address - Phone:817-277-2202
Mailing Address - Fax:817-548-9709
Practice Address - Street 1:901 MEDICAL CENTRE DR STE C
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-4700
Practice Address - Country:US
Practice Address - Phone:817-277-2202
Practice Address - Fax:817-548-9709
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0809207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033845101Medicaid
TX0346960001Medicare NSC
TX00HC20Medicare PIN
TXB21194Medicare UPIN