Provider Demographics
NPI:1760481873
Name:BENAMU, JOSE E (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:E
Last Name:BENAMU
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 1:13725 NORTHWEST BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-5124
Mailing Address - Country:US
Mailing Address - Phone:361-387-9413
Mailing Address - Fax:361-387-9616
Practice Address - Street 1:13725 NORTHWEST BLVD
Practice Address - Street 2:STE 120
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-5127
Practice Address - Country:US
Practice Address - Phone:361-387-9413
Practice Address - Fax:361-387-9616
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2023-03-27
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
TXK1358207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096267204Medicaid
TX096267201Medicaid
TXTXB150054OtherWELLMED PTAN
TX096267201Medicaid
TX00060GMedicare ID - Type Unspecified