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General NPI Number Information
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NPI Number | 1518162247
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Entity Type | Individual
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Provider Name | BENJAMIN JOHN ERNST M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/21/2007
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Last Update Date | 09/21/2023
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Provider Practice Location Address
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Address Line | 442 N WESTHILL BLVD STE A
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City | APPLETON
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State | WI
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Zip | 54914-5830
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Country | US
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Telephone | 920-751-8666
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Fax |
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Provider Business Mailing Address
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Address Line | 442 N WESTHILL BLVD STE A
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City | APPLETON
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State | WI
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Zip | 54914-5830
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Country | US
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Telephone | 920-751-8666
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Fax | 920-751-0288
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 48790
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number | 57459020
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License Number State | WI
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