Individual
FORTUNATO PEREZ-BENAVIDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
602 INDIANA AVE, NICU, UNIVERSITY MEDICAL CENTER, LUBBOCK, TX 79415-3364
(806) 775-8808
(806) 775-9181
Mailing address
306 VICKSBURG AVE, LUBBOCK, TX 79416-3105
(806) 797-6053
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
H8794
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
141691903
—
TX
Enumeration date
04/03/2006
Last updated
07/08/2007
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