Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 04/16/2018
Last Update Date: 12/26/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3631 BIENVILLE BLVD
OCEAN SPRINGS MS
39564-5702
US

IV. Provider business mailing address

SAN ANTONIO MIL MED CENTER 3551 ROGER BROOKE DR MCHE-ZDM-M
SAN ANTONIO TX
78234
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 TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number32455
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number32386
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: