Healthcare Provider Details

I. General information

NPI: 1124161922
Provider Name (Legal Business Name): STANLEY HAROLD BENNETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 338
WINDOM MN
56101-0338
US

IV. Provider business mailing address

PO BOX 338
WINDOM MN
56101-0338
US

V. Phone/Fax

Practice location:
  • Phone: 507-831-1703
  • Fax: 507-832-8168
Mailing address:
  • Phone: 507-831-1703
  • Fax: 507-832-8168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number38102
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMN38102
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: