Provider Demographics
NPI:1508853722
Name:WOUTERS, BEN C (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:C
Last Name:WOUTERS
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 PINE ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1103
Mailing Address - Country:US
Mailing Address - Phone:334-834-1300
Mailing Address - Fax:334-834-8347
Practice Address - Street 1:1722 PINE ST
Practice Address - Street 2:SUITE 700
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1103
Practice Address - Country:US
Practice Address - Phone:334-834-1300
Practice Address - Fax:334-834-8347
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL208602084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL34770Medicaid
ALBW4555984OtherDEA
AL34770Medicaid
ALBW4555984OtherDEA