Provider Demographics
NPI:1366426900
Name:BENZAQUEN, MAX P (MD)
Entity type:Individual
Prefix:
First Name:MAX
Middle Name:P
Last Name:BENZAQUEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:224 S WOODS MILL RD
Mailing Address - Street 2:STE 290 SOUTH
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3451
Mailing Address - Country:US
Mailing Address - Phone:314-878-8744
Mailing Address - Fax:314-878-2234
Practice Address - Street 1:224 SOUTH WOODS MILL ROAD
Practice Address - Street 2:SUITE 290 SOUTH
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3451
Practice Address - Country:US
Practice Address - Phone:314-878-8744
Practice Address - Fax:314-878-2234
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO1005072084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
10730OtherBC
187999OtherHEALTHLINK
187999OtherHEALTHLINK