Provider Demographics
NPI:1588165542
Name:WALTERS, BENJAMIN KENNETH (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:KENNETH
Last Name:WALTERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SAN ANTONIO MILITARY MEDICAL CENTER, MCHE-ZDM-M
Mailing Address - Street 2:OTOLARYNGOLOGY RESIDENCY, 3551 ROGER BROOKE DR
Mailing Address - City:JBSA-FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4504
Mailing Address - Country:US
Mailing Address - Phone:210-292-5077
Mailing Address - Fax:210-292-7868
Practice Address - Street 1:KEESLER MEDICAL CENTER
Practice Address - Street 2:301 FISHER ST
Practice Address - City:KEESLER AIR FORCE BASE
Practice Address - State:MS
Practice Address - Zip Code:39534
Practice Address - Country:US
Practice Address - Phone:228-376-0418
Practice Address - Fax:228-376-4041
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01083351A207Y00000X, 208D00000X
390200000X
MS31534207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program