Healthcare Provider Details

I. General information

NPI: 1982198503
Provider Name (Legal Business Name): BENJAMIN LAMBERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 SUNSET DR STE B
GRENADA MS
38901-4081
US

IV. Provider business mailing address

1300 SUNSET DR STE B
GRENADA MS
38901-4081
US

V. Phone/Fax

Practice location:
  • Phone: 662-227-7220
  • Fax: 662-377-2667
Mailing address:
  • Phone: 662-227-7220
  • Fax: 662-377-2667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number26914
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: