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General NPI Number Information
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NPI Number | 1477086239
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Entity Type | Individual
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Provider Name | ADRIAN BENNETT DO
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Gender | Male
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Dates
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Enumeration Date | 04/09/2017
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Last Update Date | 12/26/2024
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Provider Practice Location Address
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Address Line | 325 SPRING ST
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City | RED BUD
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State | IL
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Zip | 62278-1105
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Country | US
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Telephone | 618-282-3831
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Fax |
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Provider Business Mailing Address
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Address Line | 1119 MISSISSIPPI AVE APT 210
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City | SAINT LOUIS
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State | MO
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Zip | 63104-2449
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Country | US
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Telephone |
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Fax |
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 341333
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 036154316
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | BP10058790
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036.154316
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License Number State | IL
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