Individual
DR. BENJAMIN WILSON COVINGTON IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
730 EUREKA ST, WEATHERFORD, TX 76086-6546
(817) 514-6193
(817) 514-6947
Mailing address
PO BOX 26804, BENBROOK, TX 76126-0804
(817) 514-6193
(817) 514-6947
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
L5709
TX
207Q00000X
Family Medicine Physician
Primary
L5709
TX
208M00000X
Hospitalist Physician
L5709
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
169989404
—
TX
05
—
170802601
—
TX
01
—
8P2300
BLUE CROSS BLUE SHIELD
TX
01
—
DC3066
RAILROAD MEDICARE
TX
01
—
P00997727
RAILROAD
TX
Enumeration date
08/10/2005
Last updated
01/28/2013
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