Healthcare Provider Details

I. General information

NPI: 1073734794
Provider Name (Legal Business Name): JONATHAN CHRISTOPHER BENNETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 6TH ST S
ST PETERSBURG FL
33701-4814
US

IV. Provider business mailing address

701 6TH ST S
ST PETERSBURG FL
33701-4814
US

V. Phone/Fax

Practice location:
  • Phone: 727-893-6182
  • Fax: 727-893-6861
Mailing address:
  • Phone: 727-893-6182
  • Fax: 727-893-6861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number67958
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number99058473A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number0600003440
License Number StateVT
# 4
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number4301504318
License Number StateMI
# 5
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME182553
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: