Provider Demographics
NPI:1750529079
Name:BENAFIELD, THOMAS R (CRNA)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:BENAFIELD
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-5302
Mailing Address - Country:US
Mailing Address - Phone:409-772-1221
Mailing Address - Fax:
Practice Address - Street 1:100 N 30TH ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-3117
Practice Address - Country:US
Practice Address - Phone:580-323-2363
Practice Address - Fax:580-331-1484
Is Sole Proprietor?:No
Enumeration Date:2009-01-23
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2677162367500000X
TXAP120163367500000X
OK103426367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered