Individual
DR. SAMUEL BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
305 MALLARD LN, TAYLOR, TX 76574-1208
(512) 352-4777
(512) 352-4734
Mailing address
305 MALLARD LN, TAYLOR, TX 76574-1208
(512) 352-4777
(512) 352-4734
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
G8671
TX
207R00000X
Internal Medicine Physician
G8671
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
140069926
—
TX
05
—
140069930
—
TX
01
—
P00018120
RAILROAD MEDICARE
—
Enumeration date
01/19/2006
Last updated
01/11/2011
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