Individual
MR. BENJAMIN M GUENTHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
C.O.,LPO
Contact information
Practice address
1110 MEDICAL DR, TYLER, TX 75701-2109
(903) 592-5900
(903) 592-6683
Mailing address
1110 MEDICAL DR, TYLER, TX 75701-2109
(903) 592-5900
(903) 592-6683
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
OI60339265
WA
224P00000X
Prosthetist
PS60452668
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OI60339265
STATE LICENSE
WA
01
—
PS60452668
PROSTHETIC LICENSE
WA
Enumeration date
09/03/2013
Last updated
04/02/2014
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