Healthcare Provider Details

I. General information

NPI: 1851310486
Provider Name (Legal Business Name): CHRISTOPHER BENNETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 01/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 N MAIN ST
HARRISON AR
72601-2911
US

IV. Provider business mailing address

PO BOX 9178
RUSSELLVILLE AR
72811-9178
US

V. Phone/Fax

Practice location:
  • Phone: 479-968-7930
  • Fax: 479-968-1673
Mailing address:
  • Phone: 479-968-7930
  • Fax: 479-968-1673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberC6369
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: