Provider Demographics
NPI:1356888788
Name:KAREN BENZ, MD PA
Entity type:Organization
Organization Name:KAREN BENZ, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-479-8269
Mailing Address - Street 1:1250 8TH AVE STE 270
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4139
Mailing Address - Country:US
Mailing Address - Phone:817-927-9100
Mailing Address - Fax:817-927-9103
Practice Address - Street 1:1250 8TH AVE STE 270
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4139
Practice Address - Country:US
Practice Address - Phone:817-927-9100
Practice Address - Fax:817-927-9103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-24
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4243207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX511917YSE6Medicare PIN