Provider Demographics
NPI:1770853368
Name:DR. BENJAMIN D. ERNST, D.O. LTD. LLP
Entity type:Organization
Organization Name:DR. BENJAMIN D. ERNST, D.O. LTD. LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ERNST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-915-9814
Mailing Address - Street 1:3349 S HWY 181
Mailing Address - Street 2:SUITE 1
Mailing Address - City:KENEDY
Mailing Address - State:TX
Mailing Address - Zip Code:78119-5247
Mailing Address - Country:US
Mailing Address - Phone:540-915-9814
Mailing Address - Fax:
Practice Address - Street 1:3349 S HWY 181
Practice Address - Street 2:SUITE 1
Practice Address - City:KENEDY
Practice Address - State:TX
Practice Address - Zip Code:78119-5247
Practice Address - Country:US
Practice Address - Phone:540-915-9814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1543207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty