Individual provider · NPI-1

Benjamin M Azevedo, M. D., M. P H

Internal Medicine · Lake Charles, LA

NPI number1821434432
StatusActive
Last updated in NPPESFeb 3, 2022

Details

NPI
1821434432
Entity type
Individual (NPI-1)
Name
Benjamin M Azevedo
Credential
M. D., M. P H
Sex
Male
Sole proprietor
No
Enumeration date
May 22, 2013
Certification date
Feb 3, 2022
Last updated
Feb 3, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207R00000X Internal Medicine305391LAYes

Practice location

1000 Walters St
Lake Charles, LA 70607-4647

Phone 337-480-8066 · Fax 337-480-8061

Mailing address

Po Box 122108 Dept 2108
Dallas, TX 75312-2108

Phone 337-494-2772 · Fax 337-494-2928

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