Individual
DR. ETHAN BENARDETE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, PHD
Contact information
Practice address
2401 S 31ST ST, TEMPLE, TX 76508-0001
(254) 724-2111
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
25MA08891900
NJ
207T00000X
Neurological Surgery Physician
Primary
Q6810
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02460933
—
NY
05
—
0261076
—
NJ
05
—
102577524
—
PA
Enumeration date
09/13/2005
Last updated
12/07/2021
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