Doctor Name: | DR. TRACY G BENZING |
NPI Number: | 1225020498 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | DPM |
License Number: | 80182 |
Business Practice Address: | 311 Shieldsboro Sq Bay St Louis, MS - 395202823 |
Business Phone Number: | 2284672878 |
Business Fax Number: | 2284672664 |
Mailing Address: | 311 Shieldsboro Sq, BAY ST LOUIS |
State: | MS |
Postal Code: | 395202823 |
Phone Number: | 2284672878 |
Fax Number: | 2284672664 |
NPI Enumeration Date: | 08/15/2005 |
NPI Last Update Date: | 11/03/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213EP1101X |
License Number: | 80182 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Primary Podiatric Medicine |
Taxonomy Definition: |