Individual
ROBERT JOSEPH BENNETT JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
602 YALE PL, CANON CITY, CO 81212-4611
(719) 275-2301
(719) 275-7048
Mailing address
602 YALE PL, CANON CITY, CO 81212-4611
(719) 275-2301
(719) 275-7048
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
13841
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01138411
—
CO
Enumeration date
12/05/2006
Last updated
04/07/2011
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