Healthcare Provider Details

I. General information

NPI: 1831535517
Provider Name (Legal Business Name): WILLIAM BABERS BENTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7373 PERKINS RD
BATON ROUGE LA
70808
US

IV. Provider business mailing address

7373 PERKINS RD
BATON ROUGE LA
70808-4373
US

V. Phone/Fax

Practice location:
  • Phone: 225-769-4044
  • Fax: 225-246-9116
Mailing address:
  • Phone: 225-246-9790
  • Fax: 225-246-9100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number33813
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number306579
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: