=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124161922
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STANLEY HAROLD BENNETT MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2007
-----------------------------------------------------
Last Update Date | 08/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | PO BOX 338
-----------------------------------------------------
City | WINDOM
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56101-0338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-831-1703
-----------------------------------------------------
Fax | 507-832-8168
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 338
-----------------------------------------------------
City | WINDOM
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56101-0338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-831-1703
-----------------------------------------------------
Fax | 507-832-8168
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 38102
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MN38102
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------