Individual
DR. SIDNEY BENNETT
Active
Individual
DR. SIDNEY BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
R1G06
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050028631
RR MEDICARE
MO
05
—
202312625
—
MO
Enumeration date
08/22/2006
Last updated
04/29/2008
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