Provider Demographics
NPI:1902030745
Name:BENGE, WILLIAM BRET
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:BRET
Last Name:BENGE
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:PO BOX 93253
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79493-3253
Mailing Address - Country:US
Mailing Address - Phone:806-777-7993
Mailing Address - Fax:806-795-7567
Practice Address - Street 1:3210 39TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-2720
Practice Address - Country:US
Practice Address - Phone:806-777-7993
Practice Address - Fax:806-795-7567
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications