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NPI Code Detail

MEDICARE: DR. SAMUEL BENNETT M.D.

MEDICARE:  DR. SAMUEL  BENNETT  M.D.
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
1207P00000XEmergency Medicine PhysicianG8671TX
2207R00000XInternal Medicine PhysicianG8671TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00018120OTHERRAILROAD MEDICARE

Other Identifiers

General Provider Information

NPI Number : 1538149125
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SAMUEL BENNETT M.D.
Provider Business Mailing Address
First Line : 305 MALLARD LN
Second Line :
City : TAYLOR
State : TX
Zip : 76574-1208
Country : US
Telephone Number : 512-352-4777
Fax Number : 512-352-4734
Provider Business Practice Location Address
First Line : 305 MALLARD LN
Second Line :
City : TAYLOR
State : TX
Zip : 76574-1208
Country : US
Telephone Number : 512-352-4777
Fax Number : 512-352-4734
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2006
Last Update Date : 01/11/2011

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Directions to “ DR. SAMUEL BENNETT M.D.” Practice Location

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