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Individual

BONNA BENJAMIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
1901 MEDI PARK DR, STE 2051, AMARILLO, TX 79106-2169
(806) 468-4300
(806) 468-4398
Mailing address
1400 WALLACE BLVD, ATTN: CREDENTIALING DEPT, AMARILLO, TX 79106-1708
(806) 468-4300
(806) 468-4398

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
J8911
TX
2086S0120X
Pediatric Surgery Physician
Primary
J8911
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100027640A
OK
05
124606806
TX
05
124606807
TX
05
J8716
NM
Enumeration date
07/31/2006
Last updated
07/17/2013
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