Provider Demographics
NPI:1003045816
Name:BEN W. SEALE, M.D., PLLC
Entity Type:Organization
Organization Name:BEN W. SEALE, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:SEALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-948-5158
Mailing Address - Street 1:971 LAKELAND DR
Mailing Address - Street 2:SUITE 450
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4643
Mailing Address - Country:US
Mailing Address - Phone:601-948-5158
Mailing Address - Fax:601-949-6058
Practice Address - Street 1:971 LAKELAND DR
Practice Address - Street 2:SUITE 450
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4643
Practice Address - Country:US
Practice Address - Phone:601-948-5158
Practice Address - Fax:601-949-6058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19640207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty