Provider Demographics
NPI:1598075244
Name:MAYER, BENJAMIN R (DO)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:R
Last Name:MAYER
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 1:23 W MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-3298
Mailing Address - Country:US
Mailing Address - Phone:850-938-3733
Mailing Address - Fax:828-372-4504
Practice Address - Street 1:23 W MARSHALL ST
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-3298
Practice Address - Country:US
Practice Address - Phone:850-938-3733
Practice Address - Fax:828-372-4504
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01823207Q00000X
NC185376207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5922612Medicaid