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Individual

JERRY D BENNETT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
706 LEGEND LN, SHERMAN, TX 75092-5421
(903) 891-2139
Mailing address
706 LEGEND LN, SHERMAN, TX 75092-5421
(903) 814-0303

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
F9192
TX
207P00000X
Emergency Medicine Physician
Primary
F9192
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
140179633
TX
05
140179634
TX
01
85Z525
BCBS
TX
Enumeration date
08/30/2005
Last updated
03/31/2021
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