Benham, Jerry Alan

Benham, Jerry Alan is an individual health care provider with primary practice located at 6600 Fish Pond Rd Suite 201, Waco TX 76710-2581. He recently has only one registered license in Allopathic & Osteopathic Physicians / Orthopaedic Surgery, which is considered as his primary health care specialty. Benham, Jerry Alan can be contacted via phone (254) 752-9638.

Contact Information

Primary practice address
6600 Fish Pond Rd Suite 201 Waco TX 76710-2581
Phone: (254) 752-9638
Fax: (254) 752-2201
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X H0173 Texas

Profile Details

NPI number 1245290972
LBN Legal business name Benham, Jerry Alan
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 25th, 2006
Last updated Dec 29th, 2009 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1245290972 NPPES
Texas MEDICAID 102133902

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