MEDICARE: DR. ERWIN 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	207X00000X	Orthopaedic Surgery Physician	MD 35119	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51178870	OTHER	AL	BLUE CROSS PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811216518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERWIN BENNETT M.D.

Provider Business Mailing Address
First Line	:	4294 LOMAC ST
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36106-3604
Country	:	US
Telephone Number	:	334-274-9000
Fax Number	:	334-274-0857

Provider Business Practice Location Address
First Line	:	6007 BERRYHILL RD
Second Line	:
City	:	MILTON
State	:	FL
Zip	:	32570-4008
Country	:	US
Telephone Number	:	334-274-9000
Fax Number	:	334-274-0857

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

Provider Enumeration Date	:	05/20/2010
Last Update Date	:	09/03/2020

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