Provider Demographics
NPI:1699752105
Name:BENITEZ, JUAN (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:
Last Name:BENITEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9330 PARK WEST BLVD STE 506
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4313
Mailing Address - Country:US
Mailing Address - Phone:865-539-5372
Mailing Address - Fax:865-539-5369
Practice Address - Street 1:9330 PARK WEST BLVD STE 506
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4313
Practice Address - Country:US
Practice Address - Phone:865-539-5372
Practice Address - Fax:865-539-5369
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37313207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ022507Medicaid
TN3883441Medicaid
TN3883441Medicaid