Provider Demographics
NPI:1487911186
Name:OB/GYN CENTER BENSON
Entity type:Organization
Organization Name:OB/GYN CENTER BENSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROYAL
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:979-224-3893
Mailing Address - Street 1:915 PARK LN
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-4358
Mailing Address - Country:US
Mailing Address - Phone:979-224-3893
Mailing Address - Fax:
Practice Address - Street 1:3740 COPPERFIELD DR STE 105
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-5933
Practice Address - Country:US
Practice Address - Phone:979-224-3893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXHO175261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service