Provider Demographics
NPI:1669783668
Name:SMITH, BENJAMIN PROBIE (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:PROBIE
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:301 FISHER ST
Mailing Address - Street 2:ATTN INTERNAL MEDICINE CLINIC
Mailing Address - City:KEESLER AFB
Mailing Address - State:MS
Mailing Address - Zip Code:39534-2508
Mailing Address - Country:US
Mailing Address - Phone:228-376-0577
Mailing Address - Fax:228-376-0103
Practice Address - Street 1:301 FISHER ST
Practice Address - Street 2:ATTN INTERNAL MEDICINE CLINIC
Practice Address - City:KEESLER AFB
Practice Address - State:MS
Practice Address - Zip Code:39534-2508
Practice Address - Country:US
Practice Address - Phone:228-376-0577
Practice Address - Fax:228-376-0103
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2023-09-28
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Provider Licenses
StateLicense IDTaxonomies
MS21815208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist