Provider Demographics
NPI:1679592026
Name:BENVENUTO, PAMELA LOUISE (MD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:LOUISE
Last Name:BENVENUTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8105 DANFORTH CV
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-4931
Mailing Address - Country:US
Mailing Address - Phone:512-422-3571
Mailing Address - Fax:512-327-5508
Practice Address - Street 1:8105 DANFORTH CV
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-4931
Practice Address - Country:US
Practice Address - Phone:512-422-3571
Practice Address - Fax:512-327-5508
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2642207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine