Individual
JERRY ALAN BENHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6600 FISH POND RD, SUITE 201, WACO, TX 76710-2581
(254) 752-9638
(254) 752-2201
Mailing address
6600 FISH POND RD, SUITE 201, WACO, TX 76710-2581
(254) 752-9638
(254) 752-2201
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
H0173
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102133902
—
TX
Enumeration date
03/25/2006
Last updated
12/29/2009
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