Provider Demographics
NPI:1669423489
Name:HYMAN, BENJAMIN (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:HYMAN
Suffix:
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 1:816 W. CANNON ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3146
Mailing Address - Country:US
Mailing Address - Phone:817-321-0404
Mailing Address - Fax:
Practice Address - Street 1:627 TURTLE CREEK DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701
Practice Address - Country:US
Practice Address - Phone:817-321-0404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL309062085R0202X
TXM41852085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051116381OtherBCBS
AL051116383OtherBCBS
AL129279Medicaid
AL051116368OtherBCBS
AL129266Medicaid
AL129270Medicaid
AL129281Medicaid
AL129264Medicaid
AL129268Medicaid
AL051116369OtherBCBS
AL051116382OtherBCBS
AL051116380OtherBCBS
AL129262Medicaid
AL129267Medicaid
AL129273Medicaid
AL051116371OtherBCBS
MS06072724Medicaid
AL051116366OtherBCBS
AL051116379OtherBCBS
AL051116384OtherBCBS
AL129276Medicaid
TX8W0859OtherBC/BS OF TEXAS
AL051116371OtherBCBS
AL051116382OtherBCBS
AL051116380OtherBCBS
MS06072724Medicaid
AL129279Medicaid
TX8G7437Medicare PIN