MEDICARE: GIRLY 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	2084P0800X	Psychiatry Physician	M3906	TX

General Provider Information

NPI Number	:	1891731931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GIRLY BENNETT M.D.

Provider Business Mailing Address
First Line	:	6711 S NEW BRAUNFELS AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-3005
Country	:	US
Telephone Number	:	210-532-8811
Fax Number	:

Provider Business Practice Location Address
First Line	:	6711 S NEW BRAUNFELS AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-3005
Country	:	US
Telephone Number	:	210-532-8811
Fax Number	:

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

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	07/28/2024

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