Healthcare Provider Details

I. General information

NPI: 1215103445
Provider Name (Legal Business Name): BEN A. VIERRA, APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 WILSON ST STE C-2
LAFAYETTE LA
70503-2439
US

IV. Provider business mailing address

901 WILSON ST STE C-2
LAFAYETTE LA
70503-2439
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License NumberDPM.PD034R
License Number StateLA

VIII. Authorized Official

Name: DR. JEFFERY RYAN GRIZZAFFI
Title or Position: OWNER
Credential: DPM
Phone: 337-232-3576