Healthcare Provider Details

I. General information

NPI: 1447252168
Provider Name (Legal Business Name): RICHARD L BENNETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 NICHOLASVILLE RD
LEXINGTON KY
40503-1431
US

IV. Provider business mailing address

2121 RICHMOND RD STE 221
LEXINGTON KY
40502-1213
US

V. Phone/Fax

Practice location:
  • Phone: 859-260-2198
  • Fax:
Mailing address:
  • Phone: 859-396-4346
  • Fax: 859-269-4120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number20182
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: