Healthcare Provider Details

I. General information

NPI: 1730185802
Provider Name (Legal Business Name): BENJAMIN B. CLOSE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 PECAN PARK AVE
ALEXANDRIA LA
71303-3361
US

IV. Provider business mailing address

201 PECAN PARK AVE
ALEXANDRIA LA
71303-3361
US

V. Phone/Fax

Practice location:
  • Phone: 318-445-6221
  • Fax: 318-445-5399
Mailing address:
  • Phone: 318-445-6221
  • Fax: 318-445-5399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD.019414
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number019414
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License NumberMD.019414
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: