Individual
DR. BRIAN D. BENNEYWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
705 RILEY HOSPITAL DR, ROC 4270, INDIANAPOLIS, IN 46202-5109
(317) 274-7208
(317) 274-3442
Mailing address
PO BOX 1026, INDIANAPOLIS, IN 46206-1026
(317) 274-1201
(317) 278-9905
Taxonomy
Speciality
Code
Description
License number
State
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
01070955
IN
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
01070955
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201061570
—
IN
01
—
P01751302
RR MEDICARE
IN
Enumeration date
03/15/2007
Last updated
01/24/2017
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