Basic Information
| Provider Information | |||||||||
| NPI: | 1750392734 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENIGAR JR | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16901 DALLAS PKWY | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | ADDISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750015226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143695522 | ||||||||
| FaxNumber: | 2143695327 | ||||||||
| Practice Location | |||||||||
| Address1: | 6839 COMMUNICATIONS PKWY | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750245991 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727337242 | ||||||||
| FaxNumber: | 9727337257 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2006 | ||||||||
| LastUpdateDate: | 01/31/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | M1508 | TX | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 612190 | 01 | TX | MEDICARE PTAN | OTHER |