Individual
DR. KEITH G BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4310 S MULBERRY ST, PINE BLUFF, AR 71603-7030
(870) 541-8747
Mailing address
PO BOX 2650, PINE BLUFF, AR 71613-2650
(870) 547-7211
(870) 541-4297
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
C6572
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
115670001
—
AR
Enumeration date
06/27/2006
Last updated
01/27/2023
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