MEDICARE: STANLEY R 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	207Q00000X	Family Medicine Physician	15090	AZ

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

General Provider Information

NPI Number	:	1952380420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STANLEY R BENNETT MD

Provider Business Mailing Address
First Line	:	1300 N 12TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2848
Country	:	US
Telephone Number	:	602-562-3012
Fax Number	:	602-282-9666

Provider Business Practice Location Address
First Line	:	1300 N 12TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2848
Country	:	US
Telephone Number	:	602-562-3012
Fax Number	:	602-282-9666

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

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	02/09/2026

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Directions to “ STANLEY R BENNETT MD” Practice Location

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