Provider Demographics
NPI:1972543817
Name:BENITEZ, GARY T (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:T
Last Name:BENITEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1766 CONNELLY SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-7827
Mailing Address - Country:US
Mailing Address - Phone:828-728-8224
Mailing Address - Fax:828-728-1690
Practice Address - Street 1:1766 CONNELLY SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-7827
Practice Address - Country:US
Practice Address - Phone:828-728-8224
Practice Address - Fax:828-728-1690
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9501491207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC14861OtherBCBS
NC8914861Medicaid
NC1972543817Medicaid
NC14861OtherBCBS