Provider Demographics
NPI:1700992187
Name:VIERRA, BEN A (DPM)
Entity type:Individual
Prefix:
First Name:BEN
Middle Name:A
Last Name:VIERRA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51985
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-1985
Mailing Address - Country:US
Mailing Address - Phone:337-232-3576
Mailing Address - Fax:337-233-2816
Practice Address - Street 1:601 WEST ST MARY BLVD
Practice Address - Street 2:STE 106
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506
Practice Address - Country:US
Practice Address - Phone:337-232-3576
Practice Address - Fax:337-233-0816
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD034R213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1318191Medicaid
LA56271Medicare PIN
LA1318191Medicaid