Organization
JASPER FAMILY MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH ANN BENTON (SOLE OWNER)
(281) 220-7549
Entity
Organization
Contact information
Practice address
150 W GIBSON ST, JASPER, TX 75951-4936
(409) 384-1700
(409) 384-1701
Mailing address
150 W GIBSON ST, JASPER, TX 75951-4936
(409) 384-1700
(409) 384-1701
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
1163
TX
207Q00000X
Family Medicine Physician
K4930
TX
363A00000X
Physician Assistant
PA03271
TX
363L00000X
Nurse Practitioner
Primary
676518
TX
Other
Enumeration date
05/18/2008
Last updated
11/14/2008
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