Jaime C Benton MD PA – Family Medicine Physician

Key facts

NPI: 1720154529
Entity type: Organization (NPI type 2)
Primary specialty: Family Medicine Physician 207Q00000X
License: M0619 (TX)
Legal business name: JAIME C BENTON MD PA
Practice address: 500 E Washington
Navasota, TX 77868-3002
Phone: (936) 825-6444
Fax: (936) 825-3340
NPI assigned: Nov 27, 2006
Organization subpart: No

Authorized official

Name: Jaime C Benton, MD PA
Title: Owner Primary Care Physician
Phone: (936) 825-6444

National Provider Directory

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Family Medicine Physician Group: 193400000X SINGLE SPECIALTY GROUP	207Q00000X	M0619	TX	Yes

Addresses

Primary practice location

500 E Washington
Navasota, TX 77868-3002

Mailing address

500 E Washington
Navasota, TX 77868-3002
Phone (936) 825-6444

Other identifiers

Identifier	Type	State	Issuer
M0619	Other	TX	PHYSICIAN PERMIT

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 22, 2020.

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720154529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 E WASHINGTON",
            "city": "NAVASOTA",
            "state": "TX",
            "postal_code": "778683002",
            "telephone_number": "936-825-6444",
            "fax_number": "936-825-3340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 E WASHINGTON",
            "city": "NAVASOTA",
            "state": "TX",
            "postal_code": "778683002",
            "telephone_number": "936-825-6444",
            "fax_number": "936-825-3340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAIME C BENTON MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BENTON",
        "authorized_official_first_name": "JAIME",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER PRIMARY CARE PHYSICIAN",
        "authorized_official_telephone_number": "936-825-6444",
        "authorized_official_credential": "MD PA"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "M0619",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN PERMIT",
            "identifier": "M0619",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Navasota, TX

All providers in Navasota, TX · Family Medicine Physician in Texas

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.