MEDICARE: ROBERT D. BENNETT M.D.

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	2084P0800X	Psychiatry Physician	F6433	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083600456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT D. BENNETT M.D.

Provider Business Mailing Address
First Line	:	6330 LBJ FWY
Second Line	:	SUITE 150
City	:	DALLAS
State	:	TX
Zip	:	75240-6431
Country	:	US
Telephone Number	:	972-386-7979
Fax Number	:	972-494-3062

Provider Business Practice Location Address
First Line	:	6330 LBJ FWY
Second Line	:	SUITE 150
City	:	DALLAS
State	:	TX
Zip	:	75240-6431
Country	:	US
Telephone Number	:	972-386-7979
Fax Number	:	972-494-3062

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	01/26/2009

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