Provider Demographics
NPI:1013195395
Name:WILLIAMS, BENJAMIN BRYCE (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:BRYCE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:501 DR MICHAEL DEBAKEY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5724
Mailing Address - Country:US
Mailing Address - Phone:337-312-8258
Mailing Address - Fax:337-312-6711
Practice Address - Street 1:771 E BAYOU PINES DR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7183
Practice Address - Country:US
Practice Address - Phone:337-433-1212
Practice Address - Fax:337-433-0736
Is Sole Proprietor?:No
Enumeration Date:2008-02-08
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAMD204397207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1031879Medicaid
LAP00916202Medicare PIN
LA4Q0107460Medicare PIN