MEDICARE: RICHARD J 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
1	207L00000X	Anesthesiology Physician	19375	NV

General Provider Information

NPI Number	:	1699112185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD J BENNETT MD

Provider Business Mailing Address
First Line	:	3650 N RANCHO DR STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3151
Country	:	US
Telephone Number	:	970-396-3089
Fax Number	:	763-310-3925

Provider Business Practice Location Address
First Line	:	3650 N RANCHO DR STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3151
Country	:	US
Telephone Number	:	970-396-3089
Fax Number	:	763-310-3925

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

Provider Enumeration Date	:	05/24/2013
Last Update Date	:	10/31/2024

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