Provider Demographics
NPI:1194919639
Name:BENAVIDES, EDGARDO (DO)
Entity type:Individual
Prefix:
First Name:EDGARDO
Middle Name:
Last Name:BENAVIDES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7500 BARLITE BLVD STE 313
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78224-1363
Mailing Address - Country:US
Mailing Address - Phone:210-928-2273
Mailing Address - Fax:210-928-7272
Practice Address - Street 1:12650 NACOGDOCHES RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-2118
Practice Address - Country:US
Practice Address - Phone:210-656-4363
Practice Address - Fax:210-599-1251
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM7037207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine