Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 80183 | MS |
NPI | 1255332458 |
---|---|
Provider Name | Dr. Jeffrey R Benzing |
First Address | Bay St Louis, MS 39520-1638 |
Second Address | Bay St Louis, MS 39520-1638 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 06/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U66968 | (02) | MS |