Individual
MATTHEW P BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2804 DR JOHN HAYNES DR, PELL CITY, AL 35125-1438
(205) 338-6655
(205) 338-6658
Mailing address
2804 DR JOHN HAYNES DR, PELL CITY, AL 35125-1438
(205) 338-6655
(205) 338-6658
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
15383
AL
207LP2900X
Pain Medicine (Anesthesiology) Physician
15383
AL
207P00000X
Emergency Medicine Physician
00015383
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000046345
—
AL
05
—
000051302
—
AL
01
—
051051302
BCBS PROVIDER NUMBER
AL
05
—
051550606
—
AL
05
—
051557203
—
AL
05
—
137875
—
AL
01
—
51046345
BLUE CROSS BLUE SHIELD
AL
01
—
51051302
BLUE CROSS BLUE SHIELD
AL
01
—
515-50606
BC BS OF AL
AL
01
—
51545536
BLUE CROSS BLUE SHIELD
AL
Enumeration date
12/14/2005
Last updated
05/15/2019
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