Individual
MARY EMELEE BENJAMIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
2495 SHREVEPORT HWY STE 104, PINEVILLE, LA 71360-4044
(318) 466-4522
(318) 445-1663
Mailing address
2495 SHREVEPORT HWY STE 104, PINEVILLE, LA 71360-4044
(318) 466-4522
(318) 445-1663
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
AP03853
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1113549
—
LA
Enumeration date
11/14/2005
Last updated
10/23/2023
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