Individual
DR. KENNETH R. BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2500 NORTH STATE STREET, DEPARTMENT OF MEDICINE DIVISION OF CARDIOLOGY, JACKSON, MS 39216-4500
(601) 984-5678
(601) 984-5638
Mailing address
2500 NORTH STATE STREET, JACKSON, MS 39216-4500
(601) 984-5678
(601) 984-5638
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
05908
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00119359
—
MS
05
—
1552470
—
LA
05
—
180445
—
AL
01
—
P00462157
RAILROAD MEDICARE PTAN
MS
01
—
RR 060049688
RAILROAD
MS
Enumeration date
06/16/2006
Last updated
01/27/2016
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