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General NPI Number Information
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NPI Number | 1144205899
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Entity Type | Individual
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Provider Name | MATTHEW P BENNETT MD
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Gender | Male
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Dates
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Enumeration Date | 12/14/2005
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Last Update Date | 05/15/2019
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Provider Practice Location Address
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Address Line | 2804 DR JOHN HAYNES DR
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City | PELL CITY
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State | AL
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Zip | 35125-1438
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Country | US
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Telephone | 205-338-6655
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Fax | 205-338-6658
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Provider Business Mailing Address
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Address Line | 2804 DR JOHN HAYNES DR
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City | PELL CITY
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State | AL
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Zip | 35125-1438
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Country | US
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Telephone | 205-338-6655
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Fax | 205-338-6658
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 00015383
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 15383
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 15383
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License Number State | AL
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