Provider Demographics
NPI:1265228951
Name:ERIC SIDARIS BENNOS MD PA
Entity type:Organization
Organization Name:ERIC SIDARIS BENNOS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:SIDARIS
Authorized Official - Last Name:BENNOS, MD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-243-2432
Mailing Address - Street 1:PO BOX 271387
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75027-1387
Mailing Address - Country:US
Mailing Address - Phone:972-358-0426
Mailing Address - Fax:972-539-6485
Practice Address - Street 1:6000 BAY PARK CT
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-5576
Practice Address - Country:US
Practice Address - Phone:972-358-0426
Practice Address - Fax:972-539-6485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty