Individual
MRS. PATRICIA A BENOIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1337 S SAM HOUSTON BLVD, HOUSTON, MO 65483-2046
(417) 967-5639
(417) 967-5667
Mailing address
1337 S SAM HOUSTON BLVD, HOUSTON, MO 65483-2046
(417) 967-5639
(417) 967-5667
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2008016594
MO
208000000X
Pediatrics Physician
01063028A
IN
208000000X
Pediatrics Physician
2008016594
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
172978001
—
AR
05
—
1942359005
—
MO
01
—
26D0889777
CLIA
MO
01
—
431560263
TRICARE WEST
—
01
—
P00653959
RAILROAD MEDICARE
—
Enumeration date
01/09/2007
Last updated
11/19/2018
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