MEDICARE: MR. GEORGE JOSEPH BENNETT CRNA

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	282NC2000X	Children's Hospital	031637	FL
2	367500000X	Certified Registered Nurse Anesthetist	ARNP1882762	FL

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
2	G1091	OTHER	FL	BCBS OF FLORIDA

General Provider Information

NPI Number	:	1275666364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GEORGE JOSEPH BENNETT CRNA

Provider Business Mailing Address
First Line	:	2628 ARBOR LN
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-6126
Country	:	US
Telephone Number	:	561-204-4513
Fax Number	:	561-204-4513

Provider Business Practice Location Address
First Line	:	2628 ARBOR LN
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-6126
Country	:	US
Telephone Number	:	561-204-4513
Fax Number	:	561-204-4513

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	08/29/2011

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