Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 25015 | MS |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 54143 | TN |
NPI | 1700176203 |
---|---|
Provider Name | Benjamin West Sheffer |
First Address | Germantown, TN 38138-2205 |
Second Address | Southaven, MS 38671-5806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2011 |
Last Update Date | 01/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04451561 | (05) | MS |
218161001 | (05) | AR |
Q025042 | (05) | TN |