Individual
SLATER BENJAMIN LOWRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
362 PARK CREEK DRIVE, COLUMBUS, MS 39705-1324
(662) 244-8864
(662) 244-8874
Mailing address
362 PARK CREEK DR, COLUMBUS, MS 39705-1326
(662) 244-8864
(662) 244-8874
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
00013753
AL
207R00000X
Internal Medicine Physician
Primary
11050
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00119201
—
MS
01
—
11050
MS LICENSE #
MS
01
—
25D0981538
CLIA
MS
01
—
640933050
TAX ID
MS
01
—
73003895
ALABAMA LICENSE #
AL
Enumeration date
11/13/2006
Last updated
11/15/2010
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