Provider Demographics
NPI:1982828018
Name:JEFFREY M BENZICK MD PA
Entity Type:Organization
Organization Name:JEFFREY M BENZICK MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BENZICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-403-2050
Mailing Address - Street 1:12915 JONES MALTSBERGER RD STE 600
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-4277
Mailing Address - Country:US
Mailing Address - Phone:210-403-2050
Mailing Address - Fax:210-403-9890
Practice Address - Street 1:12915 JONES MALTSBERGER RD STE 600
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-4277
Practice Address - Country:US
Practice Address - Phone:210-403-2050
Practice Address - Fax:210-403-9890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL76652084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL7665OtherTX MEDICAL LICENSE