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NPI Code Detail

MEDICARE: PATRISE BENNETT MD

MEDICARE: PATRISE BENNETT MD
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
1207Q00000XFamily Medicine Physician15488MS

Other Identifiers

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

General Provider Information

NPI Number : 1407878747
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRISE BENNETT MD
Provider Business Mailing Address
First Line : 5606 OLD CANTON RD
Second Line :
City : JACKSON
State : MS
Zip : 39211-4217
Country : US
Telephone Number : 601-957-3333
Fax Number : 601-957-3334
Provider Business Practice Location Address
First Line : 5606 OLD CANTON RD
Second Line :
City : JACKSON
State : MS
Zip : 39211-4217
Country : US
Telephone Number : 601-957-3333
Fax Number : 601-957-3334
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2006
Last Update Date : 07/08/2007

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Directions to “ PATRISE BENNETT MD” Practice Location

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