Provider Demographics
NPI:1700176203
Name:SHEFFER, BENJAMIN WEST (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:WEST
Last Name:SHEFFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 S GERMANTOWN RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2205
Mailing Address - Country:US
Mailing Address - Phone:901-759-3100
Mailing Address - Fax:901-759-5416
Practice Address - Street 1:7545 AIRWAYS BLVD
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-5806
Practice Address - Country:US
Practice Address - Phone:901-759-3100
Practice Address - Fax:901-759-3196
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN54143207XP3100X
MS25015207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ025042Medicaid
MS04451561Medicaid
AR218161001Medicaid