Provider Demographics
NPI:1346689163
Name:NILAND, BENJAMIN ROSS (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ROSS
Last Name:NILAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BEN
Other - Middle Name:ROSS
Other - Last Name:NILAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-434-3626
Mailing Address - Fax:251-445-2464
Practice Address - Street 1:75 S UNIVERSITY BLVD UNIT 6000
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3274
Practice Address - Country:US
Practice Address - Phone:251-660-5555
Practice Address - Fax:251-660-5559
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL35917207R00000X
AL35223207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL35223OtherALABAMA MEDICAL LICENSE
SCLL35917OtherSTATE LICENSE NUMBER