# BENTON MEDICAL CLINIC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679905756
- **Authorized official:** DR. IRAM K ZANDO MD (MD/OWNER)
- **Authorized official phone:** (318) 798-4539

## Contact information

- **Practice address:** 188 BURT BLVD, BENTON, LA 71006-4900
- **Practice address phone:** (318) 798-4539
- **Practice address fax:** (318) 798-4601
- **Mailing address:** PO BOX 52364, SHREVEPORT, LA 71135-2364
- **Mailing address phone:** (318) 798-4664
- **Mailing address fax:** (318) 798-4457

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 09509R | LA | Yes |

## Other

- **Enumeration date:** 07/31/2013
- **Last updated:** 07/31/2013