Healthcare Provider Details

I. General information

NPI: 1063909158
Provider Name (Legal Business Name): BENJAMIN WALKER APPELO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2018
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3631 BIENVILLE BLVD
OCEAN SPRINGS MS
39564-5702
US

IV. Provider business mailing address

3551 ROGER BROOKE DR
FORT SAM HOUSTON TX
78234-4504
US

V. Phone/Fax

Practice location:
  • Phone: 228-875-2020
  • Fax: 228-875-2036
Mailing address:
  • Phone: 210-292-5077
  • Fax: 210-292-7868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME161231
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number32386
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number32455
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: