Individual
DR. FREDERICK S BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1162 MONTGOMERY DR STE 3, SANTA ROSA, CA 95405-4802
(707) 890-4250
Mailing address
1405 MONTGOMERY DR, SANTA ROSA, CA 95405-4557
(707) 546-1922
(707) 546-1897
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
G64646
CA
207XX0801X
Orthopaedic Trauma Physician
G64646
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G646460
CIGNA DME
CA
05
—
00G646460
—
CA
01
—
G64646
LICENSE
CA
Enumeration date
06/13/2006
Last updated
07/14/2023
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