Provider Demographics
NPI:1831104421
Name:BENJAMIN YBARRA, P.A.
Entity Type:Organization
Organization Name:BENJAMIN YBARRA, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:YBARRA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-453-5001
Mailing Address - Street 1:1810 SHILOH RD
Mailing Address - Street 2:SUITE 701
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-2419
Mailing Address - Country:US
Mailing Address - Phone:903-581-9629
Mailing Address - Fax:903-581-7597
Practice Address - Street 1:1600 N HIGHWAY 287
Practice Address - Street 2:SUITE 102
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-8853
Practice Address - Country:US
Practice Address - Phone:817-453-5001
Practice Address - Fax:817-453-2521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00165NMedicare PIN