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Individual
LAURIE E. BENTON
Active
Individual
LAURIE E. BENTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA02738
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8N9140
BLUE SHIELD
TX
Enumeration date
04/05/2006
Last updated
12/06/2021
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