MEDICARE: IRA BENNETT DPM PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	PO821	FL

General Provider Information

NPI Number	:	1043353220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IRA BENNETT DPM PA

Provider Business Mailing Address
First Line	:	1810 WELLNESS LN
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-5357
Country	:	US
Telephone Number	:	727-848-3433
Fax Number	:	727-376-4141

Provider Business Practice Location Address
First Line	:	1810 WELLNESS LN
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-5357
Country	:	US
Telephone Number	:	727-848-3433
Fax Number	:	727-376-4141

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. IRA BENNETT
Credential	:	DPM
Telephone Number	:	727-848-3433

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	10/14/2013

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