Provider Demographics
NPI:1215103445
Name:BEN A. VIERRA, APMC
Entity type:Organization
Organization Name:BEN A. VIERRA, APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:GRIZZAFFI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:337-232-3576
Mailing Address - Street 1:901 WILSON ST STE C-2
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2439
Mailing Address - Country:US
Mailing Address - Phone:337-232-3576
Mailing Address - Fax:
Practice Address - Street 1:901 WILSON ST STE C-2
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2439
Practice Address - Country:US
Practice Address - Phone:337-232-3576
Practice Address - Fax:337-233-2816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
213ES0103X
LADPM.PD034R261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatricGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1099870001Medicare NSC