MEDICARE: JEFFREY BENNIE M.D.

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	021631	TN
2	207L00000X	Anesthesiology Physician	21631	TN

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	3029953	OTHER	TN	BCBS PROVIDER NUMBER
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1316942469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY BENNIE M.D.

Provider Business Mailing Address
First Line	:	110 29TH AVE N
Second Line	:	STE 202
City	:	NASHVILLE
State	:	TN
Zip	:	37203-1448
Country	:	US
Telephone Number	:	615-327-4304
Fax Number	:	615-327-7940

Provider Business Practice Location Address
First Line	:	110 29TH AVE N
Second Line	:	STE 202
City	:	NASHVILLE
State	:	TN
Zip	:	37203-1448
Country	:	US
Telephone Number	:	615-327-4304
Fax Number	:	615-327-7940

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	08/20/2008

110 29TH AVE N STE 202
NASHVILLE, TN
37203-1448

Practice Phone: 615-327-4304
Practice Fax: 615-327-7940