Healthcare Provider Details

I. General information

NPI: 1700992187
Provider Name (Legal Business Name): BEN A VIERRA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 WEST ST MARY BLVD STE 106
LAFAYETTE LA
70506
US

IV. Provider business mailing address

PO BOX 51985
LAFAYETTE LA
70505-1985
US

V. Phone/Fax

Practice location:
  • Phone: 337-232-3576
  • Fax: 337-233-0816
Mailing address:
  • Phone: 337-232-3576
  • Fax: 337-233-2816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPD034R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: