Individual
DR. ROBERT E BENNETT JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
701 W 5TH ST, ODESSA, TX 79763-4206
(432) 335-5270
(432) 335-5354
Mailing address
701 W 5TH ST, ODESSA, TX 79763-4206
(432) 335-5270
(432) 335-5354
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
F1381
TX
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
F1381
TX
2080P0203X
Pediatric Critical Care Medicine Physician
F1381
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106254902
—
TX
01
—
89C758
BCBS
TX
Enumeration date
10/10/2006
Last updated
10/01/2010
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