Healthcare Provider Details

I. General information

NPI: 1982776944
Provider Name (Legal Business Name): STEVEN PHILLIP BENNETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDICAL CTR 9040 JACKSON AVE
TACOMA WA
98431-1100
US

IV. Provider business mailing address

MADIGAN ARMY MEDICAL CTR 9040 REID ST
TACOMA WA
98431-1100
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-1367
  • Fax: 253-968-2284
Mailing address:
  • Phone: 253-968-1367
  • Fax: 253-968-2284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD00047199
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD00047199
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00047199
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: