Healthcare Provider Details

I. General information

NPI: 1003045816
Provider Name (Legal Business Name): BEN W. SEALE, M.D., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 LAKELAND DR SUITE 450
JACKSON MS
39216-4643
US

IV. Provider business mailing address

971 LAKELAND DR SUITE 450
JACKSON MS
39216-4643
US

V. Phone/Fax

Practice location:
  • Phone: 601-948-5158
  • Fax: 601-949-6058
Mailing address:
  • Phone: 601-948-5158
  • Fax: 601-949-6058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number19640
License Number StateMS

VIII. Authorized Official

Name: DR. BEN W SEALE
Title or Position: OWNER
Credential: M.D.
Phone: 601-948-5158