Provider Demographics
NPI:1881434926
Name:THIRAVETYAN, BEN (MD)
Entity type:Individual
Prefix:MR
First Name:BEN
Middle Name:
Last Name:THIRAVETYAN
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 1:3601 FOURTH STREET, TTUHSC DEPARTMENT OF INTERNAL MEDIC
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79430
Mailing Address - Country:US
Mailing Address - Phone:806-743-6840
Mailing Address - Fax:
Practice Address - Street 1:3601 FOURTH STREET, TTUHSC DEPARTMENT OF INTERNAL MEDIC
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430
Practice Address - Country:US
Practice Address - Phone:806-743-6840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program