| NPI | 1982232419 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDY E. BENISH Physician Assistant / Owner 580-706-0511 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2020-03-30 |