Provider Demographics
NPI:1972504181
Name:BENAVIDES, ENRIQUE F III (MD)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:F
Last Name:BENAVIDES
Suffix:III
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 1:1020 E HILLSIDE RD
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-3287
Mailing Address - Country:US
Mailing Address - Phone:956-727-7303
Mailing Address - Fax:956-726-1224
Practice Address - Street 1:1020 E HILLSIDE RD
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-3287
Practice Address - Country:US
Practice Address - Phone:956-727-7303
Practice Address - Fax:956-726-1224
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9224207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100796503Medicaid
8D5725Medicare ID - Type Unspecified
TX100796503Medicaid