Provider Demographics
NPI:1952495400
Name:FANO, BENJAMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:FANO
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 1:1400 W TRENTON RD
Mailing Address - Street 2:ATTN: PHYSICIAN PRACTICE ADMINISTRATOR
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-3413
Mailing Address - Country:US
Mailing Address - Phone:956-388-2207
Mailing Address - Fax:956-289-5040
Practice Address - Street 1:301 W EXPRESSWAY 83
Practice Address - Street 2:ATTN: MCALLEN HOSPITALIST PROGRAM
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-3045
Practice Address - Country:US
Practice Address - Phone:956-632-4000
Practice Address - Fax:956-961-4286
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0164207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046849804Medicaid
TX265321YKSJMedicare PIN
TXH27809Medicare UPIN