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General NPI Number Information
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NPI Number | 1619381407
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Entity Type | Organization
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Legal Business Name | DANIEL BENNETT MD PA
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Dates
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Enumeration Date | 06/19/2014
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Last Update Date | 06/19/2014
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Provider Practice Location Address
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Address Line | 1811 EXECUTIVE SQ
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City | JONESBORO
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State | AR
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Zip | 72401-6086
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Country | US
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Telephone | 870-932-6883
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Fax | 870-972-0719
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Provider Business Mailing Address
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Address Line | 1811 EXECUTIVE SQ
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City | JONESBORO
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State | AR
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Zip | 72401-6086
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Country | US
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Telephone | 870-932-6883
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Fax | 870-972-0719
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. DANIEL BRUCE BENNETT
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Credential |
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Telephone | 870-932-6884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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