Healthcare Provider Details

I. General information

NPI: 1891731931
Provider Name (Legal Business Name): GIRLY BENNETT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 07/28/2024
Certification Date: 07/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6711 S NEW BRAUNFELS AVE
SAN ANTONIO TX
78223-3005
US

IV. Provider business mailing address

6711 S NEW BRAUNFELS AVE
SAN ANTONIO TX
78223-3005
US

V. Phone/Fax

Practice location:
  • Phone: 210-532-8811
  • Fax:
Mailing address:
  • Phone: 210-532-8811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberM3906
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: