Organization
SOUTHWEST NEUROLOGY P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RONALD S. BENNETT M.D. (PRESIDENT)
(928) 788-4260
Entity
Organization
Contact information
Practice address
5300 S HIGHWAY 95, SUITE L, FORT MOHAVE, AZ 86426-9251
(928) 788-4260
(928) 788-4262
Mailing address
PO BOX 10499, FORT MOHAVE, AZ 86427-0499
(928) 788-4260
(928) 788-4262
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
22788
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1415509-3
CORPORATION REGISTRATION
AZ
05
—
215691002
—
AZ
Enumeration date
12/31/2007
Last updated
04/30/2008
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