MEDICARE: MRS. PAMELA ANN BENNETT PA C

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	363A00000X	Physician Assistant	00514	TX

General Provider Information

NPI Number	:	1942292743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PAMELA ANN BENNETT PA C

Provider Business Mailing Address
First Line	:	6243 FAIRMONT PKWY
Second Line	:	STE 202
City	:	PASADENA
State	:	TX
Zip	:	77505-4045
Country	:	US
Telephone Number	:	281-998-2488
Fax Number	:	281-998-2482

Provider Business Practice Location Address
First Line	:	6243 FAIRMONT PKWY
Second Line	:	STE 202
City	:	PASADENA
State	:	TX
Zip	:	77505-4045
Country	:	US
Telephone Number	:	281-998-2488
Fax Number	:	281-998-2482

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

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	04/17/2008

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