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General NPI Number Information
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NPI Number | 1407067705
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Entity Type | Individual
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Provider Name | BENJAMIN C. MCINTYRE M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 10/04/2016
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Provider Practice Location Address
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Address Line | 2500 N STATE ST DEPT OF SURGERY
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City | JACKSON
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State | MS
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Zip | 39216-4500
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Country | US
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Telephone | 601-984-5452
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Fax | 601-815-3322
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Provider Business Mailing Address
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Address Line | 2500 N STATE ST DEPT OF SURGERY
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City | JACKSON
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State | MS
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Zip | 39216-4500
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Country | US
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Telephone | 601-984-5452
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Fax | 601-815-3322
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 32525
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 57007052
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 32525
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 32525
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License Number State | SC
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Taxonomy #5
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 24236
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License Number State | MS
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