Healthcare Provider Details

I. General information

NPI: 1790079325
Provider Name (Legal Business Name): WILLIAM BENJAMIN SMITH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2011
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15813 PAUL VEGA MD DR STE 402
HAMMOND LA
70403-1426
US

IV. Provider business mailing address

15813 PAUL VEGA MD DR STE 402
HAMMOND LA
70403-1426
US

V. Phone/Fax

Practice location:
  • Phone: 985-230-7350
  • Fax: 985-230-7351
Mailing address:
  • Phone: 985-230-7350
  • Fax: 985-230-7351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number303359
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number1040
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number1040
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: