MEDICARE: DR. LEO LEON 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
1	207RP1001X	Pulmonary Disease Physician	MD038307E	PA

General Provider Information

NPI Number	:	1851390306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEO LEON BENNETT M.D.

Provider Business Mailing Address
First Line	:	3851 ROGER BROOKE DR
Second Line	:
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234-4501
Country	:	US
Telephone Number	:	210-221-7849
Fax Number	:	210-221-7118

Provider Business Practice Location Address
First Line	:	3851 ROGER BROOKE DR
Second Line	:
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234-4501
Country	:	US
Telephone Number	:	210-221-7849
Fax Number	:	210-221-7118

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	07/08/2007

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