Provider Demographics
NPI:1861926461
Name:PRINCE, BENJAMIN ROBERT (DO)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ROBERT
Last Name:PRINCE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37283 SWAMP RD BLDG 8003
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3329
Mailing Address - Country:US
Mailing Address - Phone:225-254-9589
Mailing Address - Fax:
Practice Address - Street 1:1800 GOVERNMENT ST
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3931
Practice Address - Country:US
Practice Address - Phone:228-351-5833
Practice Address - Fax:228-400-9251
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS28412207Q00000X
NE1964207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine