Provider Demographics
NPI:1063909158
Name:APPELO, BENJAMIN WALKER (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:WALKER
Last Name:APPELO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:SAN ANTONIO MIL MED CENTER 3551 ROGER BROOKE DR
Mailing Address - Street 2:MCHE-ZDM-M
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78234
Mailing Address - Country:US
Mailing Address - Phone:210-292-5077
Mailing Address - Fax:210-292-7868
Practice Address - Street 1:3631 BIENVILLE BLVD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-5702
Practice Address - Country:US
Practice Address - Phone:228-875-2020
Practice Address - Fax:228-875-2036
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-16
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE32455208D00000X
390200000X
MS32386207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390200000XMedicaid