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General NPI Number Information
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NPI Number | 1851310486
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Entity Type | Individual
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Provider Name | CHRISTOPHER BENNETT MD
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Gender | Male
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 01/02/2014
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Provider Practice Location Address
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Address Line | 620 N MAIN ST
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City | HARRISON
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State | AR
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Zip | 72601-2911
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Country | US
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Telephone | 479-968-7930
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Fax | 479-968-1673
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Provider Business Mailing Address
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Address Line | PO BOX 9178
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City | RUSSELLVILLE
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State | AR
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Zip | 72811-9178
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Country | US
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Telephone | 479-968-7930
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Fax | 479-968-1673
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | C6369
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License Number State | AR
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