Individual
DR. BENSON DAITZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
505 ELM ST NE, ALBUQUERQUE, NM 87102-2500
(505) 727-4919
(505) 727-4915
Mailing address
PO BOX 25701, ALBUQUERQUE, NM 87125-0701
(505) 727-4919
(505) 727-4915
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
74-19
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00006569
—
NM
Enumeration date
08/30/2006
Last updated
07/08/2007
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