Provider Demographics
NPI:1922157486
Name:BENAE, JEAN LOUIS (MD)
Entity Type:Individual
Prefix:
First Name:JEAN LOUIS
Middle Name:
Last Name:BENAE
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 1:8000 ELDORADO PARKWAY
Mailing Address - Street 2:BUILDING E, SUITE A
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070
Mailing Address - Country:US
Mailing Address - Phone:469-631-7940
Mailing Address - Fax:877-496-2375
Practice Address - Street 1:8000 ELDORADO PARKWAY
Practice Address - Street 2:BUILDING E, SUITE A
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070
Practice Address - Country:US
Practice Address - Phone:469-631-7940
Practice Address - Fax:877-496-2375
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP8855207T00000X, 207T00000X
MS21165207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0093676OtherCIGNA
MS9474556OtherAETNA
MS00559571Medicaid
MS302I148379Medicare PIN