Provider Demographics
NPI:1215385232
Name:WALTERS, BENJAMIN (DO)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:WALTERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 S LOUISE AVE STE 2100
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-6029
Mailing Address - Country:US
Mailing Address - Phone:605-504-1100
Mailing Address - Fax:605-504-1101
Practice Address - Street 1:6100 S LOUISE AVE STE 2100
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-6029
Practice Address - Country:US
Practice Address - Phone:605-504-1100
Practice Address - Fax:605-504-1101
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101022839207X00000X
SD13638207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery