Provider Demographics
NPI:1992788087
Name:ZERTUCHE, BENJAMIN SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:SCOTT
Last Name:ZERTUCHE
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 1:1746 W GOODWIN ST
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:TX
Mailing Address - Zip Code:78064-4500
Mailing Address - Country:US
Mailing Address - Phone:830-268-5040
Mailing Address - Fax:800-769-6492
Practice Address - Street 1:1746 W GOODWIN ST
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:TX
Practice Address - Zip Code:78064-4500
Practice Address - Country:US
Practice Address - Phone:830-268-5040
Practice Address - Fax:800-769-6492
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2066207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX147996605Medicaid
TXH49002Medicare UPIN
TX147996605Medicaid