Organization
BRENT BENNETT MD PA
Active
Other names
Brent Bennett MD
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRENT L. BENNETT M.D. (OWNER/PRESIDENT)
(512) 263-7133
Entity
Organization
Contact information
Practice address
2300 LOHMANS SPUR, #106, LAKEWAY, TX 78734-6206
(512) 263-7133
(512) 263-0451
Mailing address
2300 LOHMANS SPUR, #106, LAKEWAY, TX 78734-6206
(512) 263-7133
(512) 263-0451
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
G3150
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0049KZ
BCBS OF TEXAS GROUP #
TX
05
—
167436801
—
TX
01
—
DN3479
RAILROAD MEDICARE GROUP #
TX
Enumeration date
03/10/2006
Last updated
04/08/2014
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