Organization
MAX BENZAQUEN M D PC
Active
Organization
MAX BENZAQUEN M D PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VICTORIA MARLENE SIMS (OFFICE MANAGER)
(314) 878-8744
Entity
Organization
Contact information
Practice address
224 S WOODS MILL RD, SUITE 290 SOUTH, CHESTERFIELD, MO 63017-3451
(314) 878-8744
(314) 878-2234
Mailing address
224 S WOODS MILL RD, SUITE 290 SOUTH, CHESTERFIELD, MO 63017-3451
(314) 878-8744
(314) 878-2234
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
100507
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10730
BLUE CROSS
—
Enumeration date
03/08/2007
Last updated
08/22/2020
Update your record
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