Individual
DR. SIDNEY BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2345 DOUGHERTY FERRY RD, SAINT LOUIS, MO 63122-3313
(314) 821-1256
(314) 821-1239
Mailing address
13523 BARRETT PARKWAY DR, STE 210, BALLWIN, MO 63021-3802
(314) 775-2816
(314) 775-2821
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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