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Individual
DR. RICHARD M BENNETT III
Active
Individual
DR. RICHARD M BENNETT III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
01042286A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000091691
ANTHEM PIN NUMBER
IN
01
—
100194370
GROUP MEDICAID NUMBER
IN
01
—
1487680518
GROUP NPI
IN
05
—
200003540
—
IN
Enumeration date
07/28/2006
Last updated
01/19/2024
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