Provider Demographics
NPI:1245252576
Name:BENOLD, TERRELL (MD)
Entity type:Individual
Prefix:DR
First Name:TERRELL
Middle Name:
Last Name:BENOLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1601 RIO GRANDE ST STE 340
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1162
Mailing Address - Country:US
Mailing Address - Phone:512-324-7318
Mailing Address - Fax:512-324-8018
Practice Address - Street 1:1313 RED RIVER ST STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1923
Practice Address - Country:US
Practice Address - Phone:512-324-8600
Practice Address - Fax:512-324-8616
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4822207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133728910Medicaid
TX133728903Medicaid
TX8J2162Medicare PIN
TXB21200Medicare UPIN