Individual
BENJAMIN C MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
421 S 28TH AVE, SUITE 200, HATTIESBURG, MS 39401-7206
(601) 268-5640
(601) 261-3507
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 268-5640
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
21901
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04456312
—
MS
01
—
3493860
UNITED HEALTHCARE
MS
01
—
4738806
CIGNA
MS
01
—
6060931
HEALTHSPRING
MS
01
—
9496951
AETNA
MS
Enumeration date
04/18/2008
Last updated
07/21/2020
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