Healthcare Provider Details

I. General information

NPI: 1700176203
Provider Name (Legal Business Name): BENJAMIN WEST SHEFFER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2011
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7545 AIRWAYS BLVD
SOUTHAVEN MS
38671-5806
US

IV. Provider business mailing address

1400 S GERMANTOWN RD
GERMANTOWN TN
38138-2205
US

V. Phone/Fax

Practice location:
  • Phone: 901-759-3100
  • Fax: 901-759-3196
Mailing address:
  • Phone: 901-759-3100
  • Fax: 901-759-5416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number54143
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number25015
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: