Individual
BENJAMIN GUILLERMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
250 BLOSSOM ST, STE 400, WEBSTER, TX 77598-4204
(281) 604-1300
(281) 724-0225
Mailing address
250 BLOSSOM ST, STE 400, WEBSTER, TX 77598-4204
(281) 604-1300
(281) 724-0225
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
J6979
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
045336701
—
TX
01
—
080110914
RAILROAD MEDICARE
TX
01
—
5994569
AETNA
TX
01
—
86Z063
BCBS
TX
01
—
87583Z
HMO BLUE
TX
Enumeration date
08/31/2005
Last updated
10/05/2016
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