MEDICARE: MATTHEW P BENNETT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	00015383	AL
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	15383	AL
3	207L00000X	Anesthesiology Physician	15383	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	51051302	OTHER	AL	BLUE CROSS BLUE SHIELD
4	515-50606	OTHER	AL	BC BS OF AL
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	51046345	OTHER	AL	BLUE CROSS BLUE SHIELD
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	051051302	OTHER	AL	BCBS PROVIDER NUMBER
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	51545536	OTHER	AL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1144205899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW P BENNETT MD

Provider Business Mailing Address
First Line	:	2804 DR JOHN HAYNES DR
Second Line	:
City	:	PELL CITY
State	:	AL
Zip	:	35125-1438
Country	:	US
Telephone Number	:	205-338-6655
Fax Number	:	205-338-6658

Provider Business Practice Location Address
First Line	:	2804 DR JOHN HAYNES DR
Second Line	:
City	:	PELL CITY
State	:	AL
Zip	:	35125-1438
Country	:	US
Telephone Number	:	205-338-6655
Fax Number	:	205-338-6658

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	05/15/2019

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Directions to “ MATTHEW P BENNETT MD” Practice Location

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