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DR. JOHN MICHAEL BENAVIDEZ M.D.

>> Internal Medicine >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1659686046

Individual Registrant:
DR. JOHN MICHAEL BENAVIDEZ M.D.
Gender: M
Sole Proprietor

Location and contact information for practice:
121 EL PASO RD LINCOLN COUNTY MEDICAL COMPLEX RUIDOSO, NM 88345 US
Tel: 575-630-8350  Fax: 575-630-4237

Contact information for business:
PO BOX 26666 PRESBYTERIAN HEALTHCARE SERVICES - PROVIDER ENROLLMENT ALBUQUERQUE, NM 87125-6666 US
Tel: 505-923-6770  Fax: --

Registration Information:
NPI: 1659686046
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y207R00000XAllopathic & Osteopathic Physicians
Internal Medicine
NMMD2014-0026
N390200000XStudent
Organized Health Care Education/Training Program
AZ23315

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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