Individual
MATTHEW E BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9520 W PALM LN STE 100, PHOENIX, AZ 85037-4403
(623) 388-3216
(623) 388-4902
Mailing address
9520 W PALM LN STE 100, PHOENIX, AZ 85037-4403
(623) 388-3216
(623) 388-4902
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
29486
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
628133
—
AZ
Enumeration date
12/19/2005
Last updated
04/01/2022
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