Healthcare Provider Details

I. General information

NPI: 1811216518
Provider Name (Legal Business Name): ERWIN BENNETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2010
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6007 BERRYHILL RD
MILTON FL
32570-4008
US

IV. Provider business mailing address

4294 LOMAC ST
MONTGOMERY AL
36106-3604
US

V. Phone/Fax

Practice location:
  • Phone: 334-274-9000
  • Fax: 334-274-0857
Mailing address:
  • Phone: 334-274-9000
  • Fax: 334-274-0857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD 35119
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: