Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 80182 | MS |
NPI | 1225020498 |
---|---|
Provider Name | Dr. Tracy G Benzing |
First Address | New Orleans, LA 70121-2429 |
Second Address | Bay St Louis, MS 39520-1658 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2005 |
Last Update Date | 22/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
08908534 | (05) | MS |