Healthcare Provider Details

I. General information

NPI: 1841218617
Provider Name (Legal Business Name): GRANT BENNETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 E DAVE WARD DR
CONWAY AR
72032-7825
US

IV. Provider business mailing address

800 FAIR PARK BLVD
LITTLE ROCK AR
72204-1720
US

V. Phone/Fax

Practice location:
  • Phone: 501-500-3500
  • Fax: 501-904-3620
Mailing address:
  • Phone: 501-404-8007
  • Fax: 501-904-3620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberE7329
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberLL29147
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: