Individual
BENJAMIN LAFAYETTE WIRT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2871 ACTON RD STE 100, VESTAVIA, AL 35243
(205) 716-6900
(205) 939-0293
Mailing address
2871 ACTON RD STE 100, VESTAVIA, AL 35243-2560
(205) 716-6900
(205) 939-0293
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-90
AL
363AS0400X
Surgical Physician Assistant
PA-90
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000042296
—
AL
Enumeration date
05/25/2006
Last updated
07/10/2018
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