Individual
BENJAMIN C. MCINTYRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, DEPT OF SURGERY, JACKSON, MS 39216-4500
(601) 984-5452
(601) 815-3322
Mailing address
2500 N STATE ST, DEPT OF SURGERY, JACKSON, MS 39216-4500
(601) 984-5452
(601) 815-3322
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
32525
SC
208600000X
Surgery Physician
32525
SC
208600000X
Surgery Physician
57007052
OH
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
24236
MS
2086S0122X
Plastic and Reconstructive Surgery Physician
32525
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00173530
—
MS
05
—
189604
—
MS
05
—
325259
—
SC
01
—
AA74671955
MEDICARE PTAN
SC
01
—
P01702551
RR MEDICARE PTAN
MS
Enumeration date
05/25/2007
Last updated
10/04/2016
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